마취 고위험군에서 동시에 양측 고관절 무시멘트 전치환술을 시행한 군과 단계적으로 양측 시행한 군의 비교
Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group
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목적: 동시에 양측 고관절 치환술을 시행하는 경우 장점도 있으나 마취 고위험군에서는 술 후 합병증이 보고되는 등 논란의 대상이다. 이에 저자는 마취 고위험군에서 동시 시행군과 단계적 시행군을 비교하였다. 대상 및 방법: 1991년 1월부터 2009년 1월까지 본원에서 동시에 양측 무시멘트 고관절 치환술을시행한 ASA 등급 3, 4 60명의 환자와 단계적 양측 무시멘트 고관절 치환술을 시행한 ASA 등급3, 4 60명의 환자를 비교하였다. 통계 유의성의 판정은 p 값이 0.05 이하로 하였다. 결과: 심혈관계 합병증은 동시 양측 시행군에서만 1예 발병하였고, 폐색전증은 단계적 시행군에서 2예, 동시 시행군에서 3예, 수술 부위 감염은 단계적 시행군에서 3예, 동시 시행군에서 2예,섬망은 단계적 시행군에서 4예, 동시 시행군에서 5예, 탈구는 단계적 시행군에서 2예, 동시 시행군에서 3예 발생하였다. 실혈량은 단계적 시행군에서, 수혈량은 동시 시행군에서 높게 나타났다. 재활은 동시 시행군에서 더 빨리 시행되었으나 최종 추시 시엔 통계적으로 유의하지 않았다. 입원 기간 및 비용은 단계적 시행군보다 동시 시행군에서 절감 효과를 보였다. 결론: 술 전 평가를 면밀히 한다면 마취 고위험군에서 동시 양측성 고관절 치환술이 안전한 수술법으로 고려될 수 있다.
Abstract
Purpose: Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade. Materials and Methods: We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05. Results: Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR. Conclusion: It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.
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