고령의 대퇴경부골절에서 고관절 전치환술 후 사망률에 영향을 미치는 위험인자 분석 = Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients

다국어 초록 (Multilingual Abstract)

Purpose: Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA.
Materials and Methods: Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach.
Results: The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (University of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality.
Conclusion: When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

국문 초록 (Abstract)

목적: 이중 이동성 컵을 이용한 고관절 전치환술은 고령의 대퇴 경부 골절을 치료하기 위한 수술법 중 낮은 탈구율과 불안정성의 합리적인 치료법으로 생각된다. 본 연구에서는 고관절 전치환술을 시행 받은 고령의 환자들에서의 임상 결과와사망률에 영향을 주는 위험인자를 조사하고자 하였다.
대상 및 방법: 2018년 12월부터 2020년 6월까지 147예의 환자들 중 (1) Garden stage III 또는 IV, (2) 연령이 75세 이상, (3) 추시 기간이 1년 이상인 환자들이 선정되어 총 79예가 등록되었다. 모든 수술은 전외측 접근법을 이용하여 시행되었다.
결과: 평균 추적 기간은 15.0±8.43개월이었고, 탈구는 총 1 예 관찰되었다. 사망률은 17.7% (14/79)였으며, 과거력상 악성종양이 있거나(OR=7.18, p=0.03) 치매 등 인지장애를 앓는 환자들에서 사망률이 높은 것으로 확인되었다(OR=5.48, p=0.03). 수술 전 초기 헤모글로빈 수치(OR=0.65, p=0.04) 와 낮은 UCLA 점수(OR=0.47, p=0.02)도 사망률과 연관이있었다.
결론: 고령의 대퇴 경부 골절 환자군의 치료 방법 선택에 있어서 고관절 전치환술을 고려할 경우 수술 전 헤모글로빈 수치가 낮거나 악성종양 및 인지장애의 과거력이 있는 환자들에게서 높은 사망률이 예상되기에, 수술 후 철저한 모니터링 등수술 전후 관리에 더 신중해야겠다.

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