Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Postoperative Complications of Hip Fractures in Patients with Chronic Kidney Disease

만성 신질환 환자에서 발생한 고관절부 골절의 수술 후 합병증

  • Bae, In-Tak (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Lee, Woo-Suk (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Kim, Sang-Bum (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • H대, Youn-Moo (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Park, Cheol-Yong (Department of Orthopedic Surgery, Konyang University College of Medicine)
  • 배인탁 (건양대학교 의과대학 정형외과학교실) ;
  • 이우석 (건양대학교 의과대학 정형외과학교실) ;
  • 김상범 (건양대학교 의과대학 정형외과학교실) ;
  • 허윤무 (건양대학교 의과대학 정형외과학교실) ;
  • 박철용 (건양대학교 의과대학 정형외과학교실)
  • Published : 2009.06.30

⟨ Previous Next ⟩

Abstract

Purpose: The purpose of the present study was to evaluate the factors affecting the complications and the mortality rate after surgery for hip fractures in patients with chronic kidney disease. Materials and Methods: We retrospectively analyzed 59 patients with chronic kidney disease and who were managed with surgical treatment after hip fracture between February 2001 and February 2007. The average age was 72 (range: 45~83) years old. There were 21 men and 38 women. The postoperative complications and mortality rate were analyzed according to the patients' age and gender, the comorbid medical diseases, the preoperative pulmonary function tests, the timing of the operation and the operation methods, the American Association of Anesthetists score and the estimated glomerular filtration ratio (eGFR). Results: For 59 patients with chronic kidney disease, the overall complication rate was 35.9% and the mortality rate was 15.3%. The patients with poor pulmonary function showed a high mortality rate in the postoperative period. The timing of the operation and the ASA score were associated with the postoperative complications rate and the mortality rate. Conclusion: Respiratory complications were dominant in the hip fracture patients with chronic kidney disease. The cause of death was mainly associated with pneumonia and a septic condition. Careful management must be done during the postoperative period to prevent infectious complications.

목적: 만성 신질환 환자에서 고관절부 골절의 수술 후 합병증 발생과 사망률에 영향을 미치는 인자를 분석하고자 하였다. 대상 및 방법: 2001년 02월부터 2007년 02월까지 만성 신질환 환자 중 고관절부 골절로 수술적 치료를 받았던 59예를 대상으로 하였다. 평균 연령은 72(45~83)세였고, 남자가 21예, 여자가 38예였다. 대퇴골 경부 골절은 14예, 대퇴골 전자간 골절은 45예이었다. 연령, 성별, 기존질환, 골밀도, 수술 전 폐기능 검사, 수술 시기, 수술 방법, 마취 위험도에 따른 미국마취과 학회 분류, 추정 사구체 여과율 등에 따른 수술 후 합병증과 사망률을 분석하였다. 결과: 만성 신질환을 가진 59명의 환자에서 수술 후 합병증은 35.9%, 사망률은 15.3% 이었다. 수술 전 낮은 폐기능은 수술 후 사망률을 증가시켰으며, 수술 시기, 미국마취과 학회 분류 등이 수술 후 합병증과 사망률에 영향을 주었다. 결론: 만성 신질환 환자에서 고관절부 골절의 수술 후 합병증은 호흡기 계통의 질환이 많이 발생하였고, 사망의 원인은 폐렴과 패혈증에 의한 경우가 많았으므로 감염에 주의를 요한다.

Keywords

References

  1. Alem AM, Sherrard DJ, Gillen DL, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int, 58: 396-399, 2000. https://doi.org/10.1046/j.1523-1755.2000.00178.x
  2. Ballanti P, Coen G, Mazzaferro S, et al. Histomorphometric assessment of bone turnover in uremic patients: comparison between activation frequency and bone formation rate. Histopathology, 38: 571, 2001. https://doi.org/10.1046/j.1365-2559.2001.01139.x
  3. Ceder L, Thorngren KG, Wallden B. Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop Relat Res, 152: 173-184, 1980.
  4. Choi JC, Na HY, Lee YS, et al. Mortality after treatment of hip fracture over 80 years old. J Korean Hip Soc, 18: 116-200, 2006.
  5. Dahl E. Mortality and life expectancy after hip fractures. Acta Orthop Scand, 51: 163-170, 1980. https://doi.org/10.3109/17453678008990781
  6. Davis TR, Sher JL, Porter BB, Checketts RG. The timing of surgery for intertrochanteric femoral fractures. Injury, 19: 244-246, 1988. https://doi.org/10.1016/0020-1383(88)90036-8
  7. Dolk T. Influence of treatment factors on the outcome after hip fractures. Ups J Med Sci, 94: 209-221, 1989. https://doi.org/10.3109/03009738909178565
  8. Elder G. Review: pathophysiology and recent advances in the management of renal osteodystrophy. J Bone Miner Res, 17: 2094-2105, 2002. https://doi.org/10.1359/jbmr.2002.17.12.2094
  9. Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ, 325: 868-869, 2002. https://doi.org/10.1136/bmj.325.7369.868
  10. Karanjit SM, Akshay M, Idnan Y, Peter N, Keith P. Is estimated peri-operative glomerular filtration rate associated with post-operative mortality in fractured neck of femur patients- Injury, 39: 1141-1146, 2008. https://doi.org/10.1016/j.injury.2008.02.034
  11. Kalra S, McBryde CW, Lawrence T. Intracapsular hip fractures in end-stage renal failure. Injury, 37: 175-184, 2006. https://doi.org/10.1016/j.injury.2005.11.006
  12. Karapinar H, Ozdemir M, Akyol S, Ulku O. Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure. Acta Orthopaed Belg, 69: 82-84, 2003.
  13. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res, 186: 45-56, 1984.
  14. Kho DH, Kim KH, Shin JY, Lee JH, Kim DH. Postoperative mortality rate o f hip fracture in elderly patients. J Korean Fracture Soc, 19: 117-121, 2006.
  15. Kim KH, Kho DW, Yang JH, Kim DH. Treatment of intertrochanteric fractures with bipolar hemiarthroplasty in the elderly. J Korean Fracture Soc, 14: 174-180, 2001.
  16. Kim SK, Hong JS, Park JH, Park JW, Kim JH. Mortality and functional recovery after bipolar hemiarthroplasty of femoral neck fractures in elderly patients. J Korean Hip Soc, 14: 49-57, 2002.
  17. Liberman JR, Fuchs MD, Haas SB, et al. Hip arthroplasty in patients with chronic renal failure. J Arthroplasty, 10: 191, 1995. https://doi.org/10.1016/S0883-5403(05)80126-3
  18. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. J Bone Joint Surg, 76-A: 15-25, 1994.
  19. Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg, 60-A: 930-933,1978.
  20. Nagoya S, Nagao M, Takada J, Kuwabara H, Kaya M, Yamashita T. Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis. J Arthroplasty, 20: 66-71, 2005. https://doi.org/10.1016/j.arth.2004.09.055
  21. Naito M, Ogata K, Shiota E, et al. Hip arthroplasty in haemodialysis patients. J Bone Joint Surg, 76-B: 428, 1994.
  22. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1): S1-S266. https://doi.org/10.1016/S0272-6386(02)70081-4
  23. Owen WD, Felts JA, Spitznagel EL. ASA, Physical status classifications: A Study of consistency of ratings. Anesthesiology, 4: 239-243, 1978.
  24. Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. J Arthroplasty, 14: 571, 1999. https://doi.org/10.1016/S0883-5403(99)90079-7
  25. Schaab PC, Murphy G, Tzamoloukos AH, et al. Femoral neck fractures in patients receiving long-term dialysis. Clin Orthop Relat Res, 260: 224-231, 1990.
  26. Soren E, Svend E. Risk factors influencing mortality after bipolar hemiarthroplasty in the treatment of fracture of the femoral neck. Clin Orthop Relat Res, 270: 295-300, 1991.
  27. Sunday JM, Guille JT, Torg JS. Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis. Clin Orthop Relat Res, 397: 350, 2002. https://doi.org/10.1097/00003086-200204000-00040
  28. Tarr RW, Kaye JJ, Nance EP. Insufficiency fractures of the femoral neck in association with chronic renal failure. South Med J, 81: 863-866, 1988. https://doi.org/10.1097/00007611-198807000-00014
  29. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg, 69-A: 1335-1340, 1987.
  30. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg, 77-A: 1551-1556, 1995.