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인공 고관절 치환술 후 심부 정맥 혈전증과 신경 및 혈관손상

Deep Vein Thrombosis and Neurovascular Injury after Total Hip Arthroplasty

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대한고관절학회 (The Korean Hip Society)|2012.12|Hip and Pelvis|제24권 제4호|pp. 279-287|DOI http://dx.doi.org/10.5371/hp.2012.24.4.279

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키워드

Deep vein thrombosisTotal hip arthroplasty인공고관절 치환술Neurovascular injury심부 정맥 혈전증신경 및 혈관 손상

초록

심부정맥 혈전증은 인공 고관절 치환술 후 비교적 흔하게 발생하는 합병증으로 하지의 동통 및 부종의 증상을 동반하며, 폐색전증으로 진행할 경우 치명적일 수 있다. 수술 자체가 위험 인자이며 비만, 심장병 등의 환자 고유의 특성도 기여를 한다. 진단은 정맥 조영술, 도플러 초음파, 컴퓨터 단층촬영 혈관 조영술, 자기공명 영상 혈관 조영술로 할 수 있다. 예방적 치료로는 기계적 방법으로 압박 스타킹과 간헐적 공기 압박기가 주로 사용되며, 약물 요법으로 warfarin, low molecular weight heparin, 트롬빈 억제제, factor Xa inhibitor 등이 예방 및 치료적 목적으로 사용될 수 있다. 인공고관절 치환술 후 신경, 혈관의 손상은 흔하지는 않지만, 발생시 치명적인 결과를 초래한다. 이를 피하기 위해서는 정확한 해부학적 구조의 인식과 적절한 수술 술기가 필요하다.

Abstract

Deep vein thrombosis (DVT) is a relatively common complication of total hip arthroplasty. DVT can accompany symptoms of pain and swelling of the lower leg, and can lead to fatal pulmonary thromboembolism. Surgical procedure is a primary risk factor, and obesity, medical status of disease, or patient’s factors could be related. Diagnostic modalities include venography, Doppler ultrasound, CT angiography, and magnetic resonance venography. Mechanical prophylaxis, such as compression stocking and use of an intermittent pneumatic compression device or a pharmacological agent, such as Warfarin, low molecular weight heparin, thrombin inhibitors, and factor Xa inhibitor can be useful. Neurovascular injury after total hip arthroplasty is an uncommon complication, but can be disastrous and fatal. To prevent this complication, the surgeon must be well acquainted with the anatomy and proper surgical skill is needed.

참고문헌 (49)

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