슬관절 인공관절 전치환술 후 심부정맥혈전증-발생 빈도와 임상적 위험인자와의 상관관계-
Deep Vein Thrombosis after Total Knee Arthroplasty -Correlation between the Incidence and Clinical Risk Factors-
1
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
목적: 슬관절 인공관절 전치환술 후 발생한 심부정맥혈전증의 발생빈도와 임상적 위험인자와의 상관관계를 비교 분석하였다. 대상 및 방법: 2008년 1월부터 2009년 1월까지 슬관절 인공관절 전치환술을 시행받은 108예를 대상으로 하였다. 34예는 적어도 하나 이상의 위험인자를 가진 고위험군, 74예는 위험인자를 가지지 않은 저위험군이었다. 결과: 고위험군 34예중 6예(17.6%)에서, 저위험군 74예 중 11예(14.9%)에서 심부정맥혈전증이 발생하여, 두 군간에 통계학적으로 유의한 차이는 없었다(p＞0.05). 그러나, 심부정맥혈전증의 위험인자 중 연령이 증가할수록, 비만도가 증가할수록 그 발생빈도는 의미있게 증가하였다(p＜0.05). 심부정맥혈전증이 발생한 17예중 4예에서는 심부정맥혈전증의 증상을 보였으며, 항혈전제로 치료하였다. 결론: 슬관절 인공관절 전치환술 후 심부정맥혈전증의 발생 빈도는 고위험군과 저위험군 간에 유의한 차이는 없었다. 심부정맥혈전증의 증상을 보인 경우는 17예 중 4예에 불과하였다. 따라서, 슬관절 인공관절 전치환술 후 심부정맥혈전증의 증상이 있는 경우에 한해서 컴퓨터 단층촬영 정맥조영술 등의 확진검사를 시행하고 항응고 약물치료를 시행하는 것이 바람직하리라 생각된다.
Abstract
Purpose: We compared and analyzed the correlation between the incidence and clinical risk factors of deep vein thrombosis (DVT) after total knee arthroplasty (TKA). Materials and Methods: One hundred eight patients underwent TKA between January 2008 and January 2009. Thirty four cases were in the high-risk group (having at least one risk factor) and 74 cases were in the low-risk group (not having any risk factors). Results: Six (17.6%) of 34 high-risk cases and 11 (14.9%) of 74 low-risk cases experienced DVT, and there were no statistically significant differences between the two groups. But among the risk factors, age and obesity had positive correlation with the incidence of DVT (p＜0.05). Among the 17 cases of DVT, 4 patients showed symptoms of DVT and they were treated with anticoagulants. Conclusion: The incidence of DVT after TKA showed no significant differences between the high and low risk groups, and among the 17 cases of DVT, 4 patients showed symptoms of DVT. Therefore, it is desirable to perform definitive diagnostic modalities like CT venography and then to treat with anticoagulants only the patients with DVT symptoms after TKA.
참고문헌 (26)
- Atik M, "Prevention of fatal pulmonary embolism", Surg Gynecol Obstet, 130, pp.403~413 (1970)
- Borow M, "Postoperative venous thrombosis. Evaluation of five methods of treatment", Am J Surg, 141, pp.245~251 (1981)
- Coche EE, "Using dual-detector helical CT angiography to detect deep venous thrombosis in patients with suspicion of pulmonary embolism: diagnostic value and additional findings", AJR Am J Roentgenol, 176, pp.1035~1039 (2001)
- Davidson BL, "Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group", Ann Intern Med, 117, pp.735~738 (1992)
- Duwe KM, "Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society", AJR Am J Roentgenol, 175, pp.1525~1531 (2000)
- Fujita S, "Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan", Clin Orthop Relat Res, (375), pp.168~174 (2000)
- Geerts WH, "American College of Chest Physicians: Prevention of venous thromboembolism: American college of chest physicians evidence -based clinical practice guidelines (8th Edition)", Chest, 133(6), pp.381~453 (2008)
- Geerts WH, "Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy", Chest, 126(3), pp.338~400 (2004)
- Haake DA, "Venous thromboembolic disease after hip surgery. Risk factors, prophylaxis, and diagnosis", Clin Orthop Relat Res, (242), pp.212~231 (1989)
- Hull RD, "Prophylaxis of venous thromboembolic disease following hip and knee surgery", J Bone Joint Surg Am, 68, pp.146~150 (1986)
- Khaw FM, "The incidence of fatal pulmonary embolism after knee replacement with no prophylactic anticoagulation", J Bone Joint Surg Br, 75, pp.940~941 (1993)
- Kim YH, "The incidence of deep vein thrombosis after cementless and cemented knee replacement", J Bone Joint Surg Br, 72, pp.779~783 (1990)
- Kim YH, "Incidence and natural history of deep-vein thrombosis after total knee arthroplasty. A prospective, randomised study", J Bone Joint Surg Br, 84, pp.566~570 (2002)
- Kim YH, "Low incidence of deep-vein thrombosis after cementless total hip replacement", J Bone Joint Surg Am, 70, pp.878~882 (1988)
- 김영진, "슬관절 전 치환술 후 심부 정맥 혈전증의 발생에 대해 D-dimer 검사의 유용성", 대한정형외과학회지, 42(4), pp.523~529 (2007), 대한정형외과학회
- Lee KB, "Deep vein thrombosis after joint arthroplasty in lower extremity: venography versus color doppler ultrasonography", J Korean Orthop Assoc, 34, pp.31~36 (1999)
- 이용재, "관절 전치환술 후 발생된 심부정맥 혈전증에서 다중검출기 컴퓨터단층촬영술의 진단적 유용성", 대한정형외과학회지, 41(1), pp.134~139 (2006), 대한정형외과학회
- McKenna R, "Thromboembolic disease in patients undergoing total knee replacement", J Bone Joint Surg Am, 58, pp.928~932 (1976)
- Morrey BF, "Complications and mortality associated with bilateral or unilateral total knee arthroplasty", J Bone Joint Surg Am, 69, pp.484~488 (1987)
- Paiement G, "Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Impedance phlebography and fibrinogen scanning versus roentgenographic phlebography", Am J Surg, 155, pp.400~404 (1988)
- Prokop M, "General principles of MDCT", Eur J Radiol, 45(1), pp.4~10 (2003)
- Sikorski JM, "The natural history and aetiology of deep vein thrombosis after total hip replacement", J Bone Joint Surg Br, 63, pp.171~177 (1981)
- 송은규, "슬관절 전 치환술 후 다중 검출기 컴퓨터 단층촬영정맥조영술을 이용한 심부정맥 혈전증의 진단", 대한정형외과학회지, 43(3), pp.294~300 (2008), 대한정형외과학회
- Stulberg BN, "Deep-vein thrombosis following total knee replacement. An analysis of six hundred and thirty-eight arthroplasties", J Bone Joint Surg Am, 66, pp.194~201 (1984)
- Warwick DJ, "Symptomatic venous thromboembolism after total knee replacement", J Bone Joint Surg Br, 79, pp.780~786 (1997)
- 유명철, "고관절 대수술 후 심부 정맥 혈전증의 발생 빈도와 D-dimer의 진단적 유용성", 대한정형외과학회지, 41(1), pp.103~109 (2006), 대한정형외과학회