혈액 투석 환자의 고관절 골절에서 시행한 무시멘트 인공 고관절 반치환술
Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis
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목적: 투석 환자의 고관절 골절에서 시행한 무시멘트 인공 고관절 반치환술의 임상적, 방사선적 결과와 합병증을 조사하였다. 대상 및 방법: 투석 환자에서 고관절 골절로 무시멘트 인공 고관절 반치환술을 시행받은 35명, 36예를 대상으로 하였다. 임상적으로 수술 후 해리스 고관절 점수, 서혜부 및 대퇴부 통증, 정형외과 및 내과적 합병증을 조사하였고 방사선적으로 대퇴 삽입물 주위 골내성장, 삽입물의 해리, 골용해, 불유합을 조사하였다. 결과: 해리스 고관절 점수는 술 후 평균 85.7점으로 29예에서 수상 전 기능을 회복하였다. 술 후 서혜부 통증은 경도 4예, 대퇴부 통증은 경도 4예, 고도 1예였다. 정형외과적 합병증은 6예(16.7%)로 경도의 혈종 3예, 표재성 감염 2예, 탈구 1예였다. 내과적 합병증은 10예(27.8%)로 패혈증 5예, 다발성 장기 부전 2예, 소화기 궤양 천공 2예, 흡인성 폐렴 1예였다. 5예(13.9%)가 수술 후 1년 내 사망했다. 대퇴 삽입물 주위 골내성장은 스템 해리 1예를 제외한 전 예에서 일어났고, 골용해나 불유합은 없었다. 결론: 투석 환자의 고관절 골절에서 무시멘트 인공 고관절 반치환술은 중기 추시 상 양호한 결과를 보여 효과적인 치료 방법이 될 것으로 생각되나 전신상태 불량에 따른 합병증 발생에 주의를 요한다.
Abstract
Purpose: This study analyzed the clinical and radiologic results and complications in patients with chronic renal failure who underwent cementless bipolar hemiarthroplasty for treatment of hip fractures. Materials and Methods: Between January 2003 and February 2010, we performed 36 consecutive cementless bipolar hemiarthroplasty procedures in 35 patients with hip fracture who were on hemodialysis for chronic renal failure. Clinically, postoperative Harris hip score, inguinal and thigh pain, and orthopaedic and medical complications were investigated. Radiologically, we examined bone ingrowth, osteolysis, loosening, and nonunion. Results: According to the Harris hip score grading system, the average postoperative score was 85.7 and the function before the injury was restored in 29 cases. Postoperatively, four patients experienced mild inguinal pain and four patients experienced mild thigh pain. One patient experienced severe thigh pain. Orthopaedic complications(6 cases, 16.7%) included mild hematoma(3 cases), superficial wound infection(2 cases), and dislocation(1 case). Medical complications(10 cases, 27.8%) included sepsis(5 cases), multiple organ failure due to aggravation of underlying diseases(2 cases), ulcer perforation(2 cases), and aspiration pneumonia(1 case). Five patients had died within one year (mortality, 13.9%). Except for loosening of the femoral stem in one case, bone ingrowth was observed in all cases. None of the patients had osteolysis and nonunion. Conclusion: Although cementless bipolar hemiarthroplasty was considered as an effective treatment in patients with hip fractureon hemodialysis due to favorable results at midterm follow-up, close attention for the postoperative medical complications due to poor general condition is needed.
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