人工股関節全置換術後に発生した脳卒中症例の検討

Stroke after Total Hip Arthroplasty

要旨：本邦では人工股関節全置換術（THA）後に発生する脳血管障害に関する報告はほとんどない．THA後に発生した脳卒中症例の頻度及び臨床的特徴を明らかにするため，1999年から2008年の間に施行された初回THA 1,267例1,551関節を対象とし後見的に調査した．周術期に脳梗塞3例（0.19％）が発症し，2例は2008年の症例であった．女性2例，男性1例で，術前合併症として糖尿病・動脈硬化があり内頚動脈の高度狭窄が認められたもの1例，心房細動1例，卵円孔開存1例であった．脳梗塞の確定診断の時期は各々術直後，術後2日，術後5日であった．全例運動麻痺が改善し脳梗塞発症後9日以内にTHA後の運動療法・作業療法に復帰し，1例は術後4週で，2例は術後8週で退院していた．本邦では近年欧米化した食生活を伴った超高齢社会を迎え，THA後の脳卒中予防は深部静脈血栓症予防と共にその重要性が強調されるべきである．

Abstract : During the perioperative period after total hip arthroplasty (THA), much attention has been recently paid to deep venous thrombosis, yet there are few reports concerning stroke after THA and there is no such data at all in Japan at present. The purpose of this retrospective study was to elucidate the occurrence rate and the characteristics of stroke cases during the THA perioperative period. A total of 1,551 primary THAs performed between January 1999 and December 2008 were investigated. Cerebral infarction occurred in three patients (0.19％) during three weeks after THA. Concerning the related factors, one male had foramen ovale, one female had untreated diabetes and atrial fibrillation, and one female had severe stenosis of the internal carotid artery. Cerebral infarction occurred at Day 1 in one male, at Day 2 in one female, and at Day 5 in the other female, and they underwent anticoagulant therapy just after their diagnosis. In all three patients, motor paralysis fully improved and they came back to the THA rehabilitation program within Day 9. One male was discharged at 4 weeks, and another two females were discharged at 8 weeks. Because many people eating a more European diet are now getting older in Japan, prophylaxis for not only DVT but also stroke after THA should be emphasized.