Herrenbruck Todd, Erickson E W, Damron Timothy A, Heiner John
Department of Orthopedic Surgery, State University of New York Health Science Center at Syracuse, Syracuse, New York, USA.
Clin Orthop Relat Res. 2002 Feb(395):154-63. doi: 10.1097/00003086-200202000-00017.
The occurrence and risk factors for adverse clinical events associated with cemented long-stem femoral arthroplasty were studied. The hypothesis was that patients with femoral metastatic disease and previously uninstrumented canals were at higher risk for such adverse events. Fifty-five consecutive patients requiring long-stem femoral arthroplasty at two institutions were retrospectively reviewed. Adverse clinical events including hypotension, sympathomimetic administration, and O 2 desaturation were subclassified according to the timing of their occurrence. Adverse events occurred in 34 of 55 patients (62%), including coma in two patients and death in a third patient. The three catastrophic events occurred in patients with metastatic disease involving previously uninstrumented femoral canals. Desaturation was more frequent in patients with metastatic disease and previously uninstrumented canals compared with patients who had revision arthroplasty and patients with previously instrumented femoral canals. Preexisting medical illness was a significant risk factor in total adverse clinical events that included cement-associated adverse clinical events and cement-associated and postoperative hypotension. In long-stem cemented femoral components risk factors for adverse clinical events included metastatic disease, uninstrumented femoral canals, and preexisting medical conditions. These findings underscore the importance of appropriate patient selection, patient and family education, and anesthesia preparation before long-stem cemented femoral arthroplasty.
我们研究了骨水泥型长柄股骨置换术相关不良临床事件的发生率及危险因素。研究假设为，患有股骨转移性疾病且之前未进行过器械操作的髓腔的患者发生此类不良事件的风险更高。我们对两家机构连续55例需要进行长柄股骨置换术的患者进行了回顾性分析。将包括低血压、使用拟交感神经药及氧饱和度下降在内的不良临床事件按照其发生时间进行了分类。55例患者中有34例（62%）发生了不良事件，其中2例患者出现昏迷，1例患者死亡。这3例灾难性事件均发生于患有转移性疾病且之前未进行过器械操作的股骨髓腔的患者。与接受翻修置换术的患者及之前进行过器械操作的股骨髓腔的患者相比，患有转移性疾病且之前未进行过器械操作的股骨髓腔的患者氧饱和度下降更为常见。既往存在的内科疾病是包括骨水泥相关不良临床事件以及骨水泥相关和术后低血压在内的总体不良临床事件的一个重要危险因素。在骨水泥型长柄股骨假体中，不良临床事件的危险因素包括转移性疾病、未进行过器械操作的股骨髓腔以及既往存在的内科疾病。这些发现强调了在进行骨水泥型长柄股骨置换术前进行恰当的患者选择、患者及家属教育以及麻醉准备的重要性。
