人工髋关节置换肝硬化患者围置换期的处理

Peri-operative treatment for total hip replacement in patients with hepatic cirrhosis

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5 d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。

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.