Hip & pelvis

  • 제21권4호
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  • Pages.356-359
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  • 2009
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  • 2287-3260(pISSN)
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  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지

무시멘트형 인공 고관절 전치환술 후 발생한 뇌 경색 - 증례 보고 -

Cerebral Infraction after Cementless Total Hip Arthroplasty - A Case Report -

  • 기성찬 (광주기독병원 정형외과) ;
  • 정영율 (광주기독병원 정형외과) ;
  • 김관우 (광주기독병원 정형외과)
  • Gi, Seong-Chan (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Chung, Young-Yool (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Kim, Gwan-Woo (Department of Orthopaedic Surgery, Kwangju Christian Hospital)
  • 발행 : 2009.12.31

⟨ 이전 논문 다음 논문 ⟩

초록

72세 남자 환자로 좌측 고관절에 비구 이형성증으로 퇴행성 골관절염이 발생하여 무시멘트형 삽입물을 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 폐쇄 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 관찰되었다. 흉부 컴퓨터 단층 촬영에서 폐 색전증 소견은 없었다. 저자들은 무시멘트형 인공 고관절 전치환술 후 다발성 미세 혈전에 의한 뇌 경색이 발생하여 문헌 고찰과 함께 보고한다.

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.

키워드

참고문헌

  1. Ammon JT, Khalily C, Lester DK. Fetal cerebral emboli in the absence of a cardiac arterial-venous shunt. Case report. J arthroplasy, 22: 477-479, 2007. https://doi.org/10.1016/j.arth.2006.03.005
  2. Brown DV, Faber LP, Tuman KJ. Perioperative stroke caused by arterial tumor embolism. Anesthe Analg, 98: 806-809, 2004.
  3. Byrick RJ, Mullen JB, Mazer CD, Guest CB. Transpulmonary systemic fat embolism. Studies in mongrel dogs after cemented arthroplasty. Am J Respir Crit Care Med, 150: 1416-1422, 1994. https://doi.org/10.1164/ajrccm.150.5.7952570
  4. Choi YW, Chung MY, Kim CJ, Lee BH, Lee HJ, Chea JS. Cerebral infarction following total hip replacement arthroplasty in geriatric patient: a case report. Korean J Anesthesiol, 52: 119-122, 2007 https://doi.org/10.4097/kjae.2007.52.1.119
  5. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg, 61-A: 15-23, 1979.
  6. Dyken ML, Wolf PA, Barnett HJM, et al. Risk factors in stroke. A statement for physicians by the subcommittee on risk factors and stroke of the Stroke Council. Stroke, 15: 1105-1111, 1984.
  7. Fabian TC. Unraveling the fat embolism syndrome. N Engl J Med, 329: 961-963, 1993. https://doi.org/10.1056/NEJM199309233291313
  8. Giachino AA, Ostrowsi J, Feibel RJ. Stroke as a complication of total joint arthroplasty. J Bone Joint Surg, 80-B (Suppl 1): S8, 1998.
  9. Hart R, Hindman B. Mechanisms of perioperative cerebral infarction. Stroke, 13: 766-773, 1982. https://doi.org/10.1161/01.STR.13.6.766
  10. Khan A, Kiryluk S, Fordyce MJ. Fatal pulmonary embolism, death rates and standardised mortality ratios after primary total hip replacement in a joint replacement centre. Hip Int, 17: 59-63, 2007.
  11. Kim JS, Mukherjee D. Current status of carotid stenting. Curr vasc pharmacol, 6: 143-147, 2008. https://doi.org/10.2174/157016108783955347
  12. Koch S, Forteza A, Lavernia C. Cerebral fat microembolism and cognitive decline after hip and knee replacement. Stroke, 38: 1079-1081, 2007. https://doi.org/10.1161/01.STR.0000258104.01627.50
  13. Koch S, Forteza A, Lavernia C, et al. Paradoxical brain embolism. Brain Nerve, 60: 1134-1143, 2008.
  14. Riding G, Daly K, Hutchinson S, Rao S, Lovell M, McCollum C. Paradoxical cerebral embolisation. An explanation for fat embolism syndrome. J Bone Joint Surg, 86-B: 95-98, 2004.
  15. Yoo MC, Cho YJ, Yim CM, Hong GP, Kim JM. Deep vein thromobosis and pulmonary embolism after cementless total hip arthroplasty. J Korean Orthop Assoc, 33: 1672-1680, 1998.