CAJ | 학술논문

背景：肝硬化对行人工关节置换等骨科治疗者往往产生负面影响，其围置换期处理是骨科医生的一大挑战。 　　目的：分析合并肝硬化患者实施人工髋关节置换的安全性、可行性。 　　方法：回顾性分析13例合并肝硬化的人工髋关节置换患者的临床资料，总结置换前后的诊治措施及疗效。 　　结果与结论：13例患者髋关节置换均顺利完成，随访均超过5个月。置换前Child-Pugh分级A级7例病例中5例置换后2周内动态观察评级仍维持A级，2例上升为B级，护肝支持治疗后均按时拆线出院。置换前B级者6例中2例置换后黄疸加剧并腹水，升为C级，其中1例置换后5d出现上消化道出血，予以生长抑素及质子泵抑制剂应用，出血迅速控制，患者经治疗均痊愈出院。随访时Harris评分髋关节的功能良好。结果提示在充分评估肝功能状况，全面围手术期处理的保障下,肝硬化患者行人工髋关节置换手术是安全可行的。
배경：간경화대행인공관절치환등골과치료자왕왕산생부면영향，기위치환기처리시골과의생적일대도전。 　　목적：분석합병간경화환자실시인공관관절치환적안전성、가행성。 　　방법：회고성분석13례합병간경화적인공관관절치환환자적림상자료，총결치환전후적진치조시급료효。 　　결과여결론：13례환자관관절치환균순리완성，수방균초과5개월。치환전Child-Pugh분급A급7례병례중5례치환후2주내동태관찰평급잉유지A급，2례상승위B급，호간지지치료후균안시탁선출원。치환전B급자6례중2례치환후황달가극병복수，승위C급，기중1례치환후5d출현상소화도출혈，여이생장억소급질자빙억제제응용，출혈신속공제，환자경치료균전유출원。수방시Harris평분관관절적공능량호。결과제시재충분평고간공능상황，전면위수술기처리적보장하,간경화환자행인공관관절치환수술시안전가행적。
BACKGROUND:Hepatic cirrhosis may adversely affect the outcome of major orthopedic surgery, such as total hip arthroplasty. Peri-operative treatment is the chal enge for al orthopedic surgeons. OBJECTIVE:To analyze the safety and feasibility of hip replacement surgeries in patients with hepatic cirrhosis. METHODS:Thirteen patients with hepatic cirrhosis that underwent hip replacement were retrospectively analyzed to evaluate the treatments and their efficacy before and after replacement. RESULTS AND CONCLUSION:Al 13 surgeries were successful y performed. Al cases were fol owed up for more than five months and were graded according to Child-Pugh Criteria for hepatic functional reserve preoperatively and postoperatively. Five cases of the seven preoperative grade A cases preserved grade A postoperatively during a two-week observation, while another two cases rose to grade B and needed hepatic conservation treatment before discharge. Two cases of the six preoperative grade B cases rose to grade C with developed jaundice and ascites. Of the two, one even suffered a complication of upper gastrointestinal hemorrhage 5 days after surgery. Somatostatin and proton pump inhibitors were administered to stop bleeding. Al cases gained a satisfying recovery. Harris hip score at fol ow-up showed favorable hip function. Hip replacement is safe and feasible for patients with hepatic cirrhosis when ful evaluation of hepatic function and appropriate perioperative management are ensured.