무시멘트형 인공 고관절 전치환술 후 발생한 뇌 경색 - 증례 보고 -
Cerebral Infraction after Cementless Total Hip Arthroplasty - A Case Report -
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72세 남자 환자로 좌측 고관절에 비구 이형성증으로 퇴행성 골관절염이 발생하여 무시멘트형 삽 입물을 이용하여 인공 고관절 전치환술을 시행하였다. 수술 다음날 좌측 상지와 하지에 마비가 발생하여 뇌 컴퓨터 단층 촬영과 자기공명 영상 촬영을 시행하여 우측 뇌에 다발성 뇌 혈관의 폐 쇄 소견이 관찰되었다. 수술 전 시행한 심초음파에서 동-정맥 션트(arterial-venous shunt)는 없었으며, 수술 후 경동맥의 초음파 검사에서 우측 경동맥에 70%이상의 협착 소견이 관찰되었 다. 흉부 컴퓨터 단층 촬영에서 폐 색전증 소견은 없었다. 저자들은 무시멘트형 인공 고관절 전치 환술 후 다발성 미세 혈전에 의한 뇌 경색이 발생하여 문헌 고찰과 함께 보고한다.
Abstract
A seventy-two year old male patient who had degenerative osteoarthritis due to acetabular dysplasia on the left hip joint was operated upon for cementless total hip arthroplasty. Sudden left hemiparesis developed on the day after the operation, so we immediately carried out brain computed tomography and magnetic resonance imaging. This showed multiple occlusions of the brain vessels at the right cerebral hemisphere. There was no arterial-venous shunt on the preoperative echocardiogram, yet the ultrasonogram of the right carotid artery showed over 70% postoperative stenosis. There was no evidence of pulmonary embolism on the chest computed tomography. We report here on a case of cerebral infarction that was caused by multiple microemboli after cementless total hip arthroplasty and we review the related medical literature.
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