探讨在转移性骨病中骨水泥型长柄髋关节置换术的并发症。
Complications of cemented long-stem hip arthroplasty in metastatic bone disease revisited.
机构信息
Department of Orthopaedics Sarcoma Services, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
出版信息
Clin Orthop Relat Res. 2013 Oct;471(10):3303-7. doi: 10.1007/s11999-013-3113-5. Epub 2013 Jun 20.
BACKGROUND
The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure.
QUESTIONS/PURPOSES: Specifically, in this study, we sought to identify (1) intraoperative complications potentially attributable to the use of cemented long-stem femoral components, and (2) early postoperative complications potentially attributable to the use of cemented long-stem femoral components in patients having an arthroplasty for metastatic bone disease.
METHODS
In this study, we performed a retrospective chart review of 42 patients (44 arthroplasties), in which the same surgical technique was used. The primary outcome measure was perioperative complications, including intraoperative cement-associated desaturation, cement-associated hypotension, sympathomimetic administration, postoperative hypotension/desaturation, and death.
RESULTS
In this series, 19% of the patients had cement-associated hypotension and sympathomimetics were administered to 48%. Two patients required prolonged intubation. One death occurred during hospitalization but there were no cardiopulmonary events.
CONCLUSIONS
This study showed that some patients experienced postoperative desaturation, prolonged intubation, and increased use of sympathomimetics, however, these events were short-lived and did not result in patient mortality. Although there are significant risks to cemented long-stem femoral arthroplasty, it can be performed with a low risk of fatal cardiopulmonary complications and remains a surgical option when treating patients with metastatic bone disease.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
背景
文献表明，骨水泥型长柄股骨假体与术中及围手术期风险增加有关。栓塞事件可能引发心肺并发症，甚至导致死亡；相比之下，也有研究报告称，在转移性骨病患者中使用骨水泥型长柄股骨假体是一种安全的手术方法。
问题/目的：具体而言，在这项研究中，我们旨在确定：（1）使用骨水泥型长柄股骨组件可能导致的术中并发症；（2）在接受转移性骨病关节置换术的患者中，使用骨水泥型长柄股骨组件可能导致的早期术后并发症。
方法
在这项研究中，我们对 42 名患者（44 例关节置换术）进行了回顾性图表分析，这些患者均采用了相同的手术技术。主要观察指标为围手术期并发症，包括术中与骨水泥相关的低氧血症、与骨水泥相关的低血压、使用拟交感神经药物、术后低血压/低氧血症和死亡。
结果
在本系列中，19%的患者出现与骨水泥相关的低血压，48%的患者使用了拟交感神经药物。两名患者需要长时间插管。一名患者在住院期间死亡，但没有心肺事件发生。
结论
本研究表明，一些患者出现术后低氧血症、长时间插管和拟交感神经药物使用增加，但这些事件是短暂的，并未导致患者死亡。尽管骨水泥型长柄股骨假体存在重大风险，但在治疗转移性骨病患者时，它仍可以安全地进行，并且是一种手术选择。
证据水平
IV 级，治疗性研究。欲了解完整的证据水平说明，请参见作者须知。
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