CAJ | 학술논문

目的：探讨因系统性红斑狼疮（ SLE ）服用皮质类固醇糖皮质激素治疗导致股骨头缺血性坏死（ ANFH）行全髋关节置换术（ THA）患者的围手术期治疗，手术安全性和初步临床疗效。方法2010年3月到2015年1月，56例（72髋） SLE并发ANFH患者行THA手术，患者年龄20岁到47岁，平均32.6岁。围手术期予以补充激素治疗，规范预防感染、深静脉血栓和抗骨质疏松治疗。回顾性总结术后髋关节功能评价及并发症情况。结果40例患者行单侧髋关节置换，16例（32髋）分二期行髋关节置换。1例术后2年发现切口感染，其余均Ⅰ级愈合，临床症状及髋关节活动度均得到明显改善。5例术后第2～3天出现不明原因的低血糖、脱水和呕吐，考虑发生肾上腺皮质危象。随访3～48个月，平均24个月。随访期末：Harris髋关节功能评分平均（82.5±8.2）分，SF-36平均（67.2±6.9）分，与术前比较改善明显（P ＜0.05）。结论 SLE患者行THA治疗激素导致ANFH，如果做好围手术期治疗，手术安全、有效。
목적：탐토인계통성홍반랑창（ SLE ）복용피질류고순당피질격소치료도치고골두결혈성배사（ ANFH）행전관관절치환술（ THA）환자적위수술기치료，수술안전성화초보림상료효。방법2010년3월도2015년1월，56례（72관） SLE병발ANFH환자행THA수술，환자년령20세도47세，평균32.6세。위수술기여이보충격소치료，규범예방감염、심정맥혈전화항골질소송치료。회고성총결술후관관절공능평개급병발증정황。결과40례환자행단측관관절치환，16례（32관）분이기행관관절치환。1례술후2년발현절구감염，기여균Ⅰ급유합，림상증상급관관절활동도균득도명현개선。5례술후제2～3천출현불명원인적저혈당、탈수화구토，고필발생신상선피질위상。수방3～48개월，평균24개월。수방기말：Harris관관절공능평분평균（82.5±8.2）분，SF-36평균（67.2±6.9）분，여술전비교개선명현（P ＜0.05）。결론 SLE환자행THA치료격소도치ANFH，여과주호위수술기치료，수술안전、유효。
Objective To evaluate the perioperative treatment in total hip replacement for ischemic necrosis of femoral head caused by corticosteroids in the patients with systemic lupus erythematosus.Methods From March 2010 to January 2015, 56 patients (72 hips) of systemic lupus erythematosus with ischemic necrosis of the femoral head underwent total hip arthroplasty , as well as hormone replacement therapy and preventive treatments for infection , deep vein thrombosis and osteoporosis during the perioperative period .The ages of the patients were 20 to 47 years, 32.6 years in average .The postoperative hip function and complications were retrospectively analysized .Results All the patients received follow-up from three months to 48 months (average 24 months).Forty cases underwent single-hip (40 hips) arthroplasty, 16 cases underwent bilateral-hip (32 hips) arthroplasty.One case was found incision infection two years after the surgery , the other cases were primary healing .Clinical symptoms and hip joint activities had been significantly improved .Unexplained hypoglycemia , vomiting and dehydration occurred in five cases on the 2nd day and 3rd day after the surgery, which were considered as adrenal crisis . At the final follow-up, the Harris hip score was (82.5 ±8.2) and SF-36 score was (67.2 ±6.9), which were significantly improved comparing with the preoperative data (P <0.05).Conclusion With proper peri-operative treatment , total hip arthroplasty is safe and effective for ischemic necrosis of femoral head caused by hormone therapy in patients with systemic lupus erythematosus .