대한정형외과학회지 (Journal of the Korean Orthopaedic Association)

  • 제56권2호
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  • Pages.125-133
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  • 2021
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  • 1226-2102(pISSN)
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  • 2005-8918(eISSN)
대한정형외과학회 (Korean Orthopaedic Association)
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고관절 전치환술 후 발생한 장요건 충돌의 관절경하 장요건 절단술

Arthroscopic Iliopsoas Tenotomy of Iliopsoas Impingement after Total Hip Arthroplasty

  • 투고 : 2020.03.09
  • 심사 : 2020.09.20
  • 발행 : 2021.04.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 고관절 전치환술 후 발생한 장요건 충돌 환자에서 관절경적 장요건 절단술이 유용한 방법인지 알아보기 위하여 임상 결과에 대하여 조사하였다. 대상 및 방법: 2013년 9월부터 2019년 12월까지 고관절 전치환술 후 지속되는 서혜부 통증 및 굴곡 시 통증을 호소하는 18명(19예 고관절)의 환자를 대상으로 하였다. 평균 연령 60세(범위, 50-69세)의 환자들에서 고관절 전치환술 후 증상발현까지는 평균 4개월(범위, 1-9개월)이 소요되었으며, 18명 환자 중 13명에는 직접전방접근법, 5명에는 측방접근법을 통한 고관절 전치환술이 시행되었다. 병력청취, 신체 검사, 혈액검사, 단순 방사선촬영과 컴퓨터 단층촬영을 이용한 영상 검사, 그리고 국소주사치료를 통하여 장요건 충돌을 진단하였다. 이들 모든 환자는 관절경적 처치를 시행받았고, 역동적 신체 검사를 통하여 술장 내에서 충돌이 이루어짐을 확인하였으며, 근육부위까지 도달하도록 관찰된 건 부위 모두에 대하여 건절단술을 시행하였다. 수술 전, 후, 추시기간의 증상 및 통증 정도에 대하여 조사하여 비교하였다. 결과: Western Ontario and McMaster Universities Osteoarthritis Index 점수는 술 전 평균 58.4점(범위, 40-88점)에서 술 후 평균 35.0점(범위, 15-76점)으로 감소하였다. 시각통증등급도 마찬가지로 술 전 평균 4.0 (범위, 2-6)에서 술 후 평균 1.4 (범위, 0-4)로 감소하였다. 16명(88.9%)에서 통증 경감 및 하지거상 시 통증의 호전을 보였으며, 2명에서는 통증 잔존과 술 후 근력 약화를 보였다. 이후 추시기간에서 근력 약화는 호전되었다. 1명의 경우 소전자부에서 장요건 건절단술을 시행하였으나 증상이 지속되었으며, 관절부에서 한 차례 더 건절단술 시행 후 임상증상의 호전을 보였다. 결론: 고관절 전치환술 후 발생한 장요건 충돌에서 고관절 관절경을 이용한 장요건 건절단술은 양호한 임상 결과를 보였다.

Purpose: The clinical outcomes were investigated to determine if arthroscopic management is a useful method for 19 hips with iliopsoas tendon impingement (IPI) after total hip arthroplasty (THA). Materials and Methods: Eighteen patients (19 hips), who complained of groin pain and flexion pain that persisted after THA from September 2013 to December 2019, were the subjects of this investigation. The mean time to manifestation after THA was four months (range, 1-9 months) in patients of an average age of 60 years (range, 50-69 years). Thirteen out of 18 patients underwent THA using the direct anterior approach and five by the lateral approach. IPI was diagnosed by the medical history, physical examination, blood test, radiographic examination using X-ray and computed tomography, and topical injection therapy. All patients underwent arthroscopic treatment and a dynamic arthroscopic physical examination after exposure to the iliopsoas tendon revealed impingement. Tenotomy was then performed on the muscle portion through the total tendon portion. Symptoms and pain levels of preoperative, postoperative and follow-up period were investigated and compared. Results: The Western Ontario and McMaster Universities Osteoarthritis Index score decreased from an average of 58.4 (range, 40-88) before surgery to an average of 35.0 (range, 15-76) after surgery. Similarly, the visual analogue scale decreased from an average of 4.0 (range, 2-6) before surgery to an average of 1.4 (range, 0-4) after surgery. Sixteen patients (88.9%) showed pain relief and improvement in the straight leg raise test, and two patients showed postoperative muscle weakness and sustained pain. In the follow-up period, muscle weakness improved. One patient underwent arthroscopic iliopsoas tenotomy at the lesser trochanteric level but the symptoms persisted. The clinical symptoms were improved after one more tenotomy at the joint level. Conclusion: Arthroscopic iliopsoas tenotomy performed in patients with IPI after THA showed good clinical results.

키워드

참고문헌

  1. Patel KA, Chhabra A, Goodwin JA, Brown JC, Hartigan DE. Arthroscopic iliopsoas release at the level of the lesser trochanter following total hip arthroplasty. Arthrosc Tech. 2017;6:e1421-6. https://doi.org/10.1016/j.eats.2017.05.023
  2. Tassinari E, Castagnini F, Mariotti F, et al. Arthroscopic tendon release for iliopsoas impingement after primary total hip arthroplasty: a retrospective, consecutive series. Hip Int. Published online December 13, 2019; doi:10.1177/1120700019893341.
  3. Trousdale RT, Cabanela ME, Berry DJ. Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty. 1995;10:546-9. https://doi.org/10.1016/S0883-5403(05)80160-3
  4. Dora C, Houweling M, Koch P, Sierra RJ. Iliopsoas impingement after total hip replacement: the results of non-operative management, tenotomy or acetabular revision. J Bone Joint Surg Br. 2007;89:1031-5.
  5. Mayne IP, Kosashvili Y, White LM, Backstein D. Iliopsoas tendonitis due to the protrusion of an acetabular component fixation screw after total hip arthroplasty. J Arthroplasty. 2010;25:659.e5-8. https://doi.org/10.1016/j.arth.2009.02.019
  6. Ilizaliturri VM Jr, Suarez-Ahedo C, Acuna M. Internal snapping hip syndrome: incidence of multiple-tendon existence and outcome after endoscopic transcapsular release. Arthroscopy. 2015;31:1991-5. https://doi.org/10.1016/j.arthro.2015.04.083
  7. Ala Eddine T, Remy F, Chantelot C, Giraud F, Migaud H, Duquennoy A. [Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:815-9. French.
  8. Poonnoose PM, Madhuri V, Palocaren T. The anteromedial approach to the psoas tendon in patients with cerebral palsy. J Child Orthop. 2007;1:249-52. https://doi.org/10.1007/s11832-007-0035-3
  9. Heaton K, Dorr LD. Surgical release of iliopsoas tendon for groin pain after total hip arthroplasty. J Arthroplasty. 2002;17:779-81. https://doi.org/10.1054/arth.2002.33570
  10. Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas impingement after primary total hip arthroplasty: operative and nonoperative treatment outcomes. J Bone Joint Surg Am. 2017;99:557-64. https://doi.org/10.2106/JBJS.16.00244
  11. Lachiewicz PF, Kauk JR. Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg. 2009;17:337-44. https://doi.org/10.5435/00124635-200906000-00002
  12. Cyteval C, Sarrabere MP, Cottin A, et al. Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases. J Comput Assist Tomogr. 2003;27:183-8. https://doi.org/10.1097/00004728-200303000-00014
  13. Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Tsuchiya H. Risk factors and cup protrusion thresholds for symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective case-control study. J Arthroplasty. 2018;33:3288-96. e1. https://doi.org/10.1016/j.arth.2018.05.017
  14. Park KK, Tsai TY, Dimitriou D, Kwon YM. Three-dimensional in vivo difference between native acetabular version and acetabular component version influences iliopsoas impingement after total hip arthroplasty. Int Orthop. 2016;40:1807-12. https://doi.org/10.1007/s00264-015-3055-5
  15. Thaunat M, Barbosa NC, Clowez G, et al. Arthroscopic identification and management of recurrent iliopsoas impingement after total hip arthroplasty. Arthrosc Tech. 2018;7:e349-53. https://doi.org/10.1016/j.eats.2017.10.003
  16. Bricteux S, Beguin L, Fessy MH. [Iliopsoas impingement in 12 patients with a total hip arthroplasty]. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:820-5. French.
  17. Yeung M, Jamshidi S, Horner N, Simunovic N, Karlsson J, Ayeni OR. Efficacy of nonsteroidal anti-inflammatory drug prophylaxis for heterotrophic ossification in hip arthroscopy: a systematic review. Arthroscopy. 2016;32:519-25. https://doi.org/10.1016/j.arthro.2015.08.007
  18. O'Connell RS, Constantinescu DS, Liechti DJ, Mitchell JJ, Vap AR. A systematic review of arthroscopic versus open tenotomy of iliopsoas tendonitis after total hip replacement. Arthroscopy. 2018;34:1332-9. https://doi.org/10.1016/j.arthro.2017.10.051
  19. O'Sullivan M, Tai CC, Richards S, Skyrme AD, Walter WL, Walter WK. Iliopsoas tendonitis a complication after total hip arthroplasty. J Arthroplasty. 2007;22:166-70. https://doi.org/10.1016/j.arth.2006.05.034
  20. Heaven S, de Sa D, Simunovic N, Williams DS, Naudie D, Ayeni OR. Hip arthroscopy in the setting of hip arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24:287-94. https://doi.org/10.1007/s00167-014-3379-5
  21. Della Valle CJ, Rafii M, Jaffe WL. Iliopsoas tendinitis after total hip arthroplasty. J Arthroplasty. 2001;16:923-6. https://doi.org/10.1054/arth.2001.26597
  22. Taher RT, Power RA. Iliopsoas tendon dysfunction as a cause of pain after total hip arthroplasty relieved by surgical release. J Arthroplasty. 2003;18:387-8. https://doi.org/10.1054/arth.2003.50047
  23. Jasani V, Richards P, Wynn-Jones C. Pain related to the psoas muscle after total hip replacement. J Bone Joint Surg Br. 2002;84:991-3. https://doi.org/10.1302/0301-620X.84B7.0840991
  24. Wank R, Miller TT, Shapiro JF. Sonographically guided injection of anesthetic for iliopsoas tendinopathy after total hip arthroplasty. J Clin Ultrasound. 2004;32:354-7. https://doi.org/10.1002/jcu.20043
  25. Gedouin JE, Huten D. Technique and results of endoscopic tenotomy in iliopsoas muscle tendinopathy secondary to total hip replacement: a series of 10 cases. Orthop Traumatol Surg Res. 2012;98:S19-25. https://doi.org/10.1016/j.otsr.2012.04.009
  26. Jerosch J, Neuhauser C, Sokkar SM. Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement. Arch Orthop Trauma Surg. 2013;133:1447-54. https://doi.org/10.1007/s00402-013-1806-6
  27. Blomberg JR, Zellner BS, Keene JS. Cross-sectional analysis of iliopsoas muscle-tendon units at the sites of arthroscopic tenotomies: an anatomic study. Am J Sports Med. 2011;39 Suppl:58S-63S.
  28. Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy. 2006;22:907.e1-4. https://doi.org/10.1016/j.arthro.2005.12.064
  29. Alpert JM, Kozanek M, Li G, Kelly BT, Asnis PD. Cross-sectional analysis of the iliopsoas tendon and its relationship to the acetabular labrum: an anatomic study. Am J Sports Med. 2009;37:1594-8. https://doi.org/10.1177/0363546509332817