Barral Marine, Lalande Laure, Viste Anthony, Besse Jean-Luc, Fessy Michel-Henri, Carre Emmanuelle
Service de Pharmacie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France.
Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France; Laboratoire de Biomécanique et Mécanique des Chocs, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, 69675 Bron cedex, France.
Orthop Traumatol Surg Res. 2019 Apr;105(2):383-388. doi: 10.1016/j.otsr.2018.11.022. Epub 2019 Feb 18.
Although cements are widely used during arthroplasty procedures, few recommendations exist regarding their optimal usage modalities, which, nevertheless, govern the long-term surgical outcomes. No detailed information is available on how cements are used in French hospitals. The objectives of this questionnaire survey among surgeons working at a multi-site university hospital in France were to describe practices, determine whether these varied with surgeon experience, and look for differences compared to recommendations.
Cementing techniques vary widely among surgeons at a university hospital.
A questionnaire was sent to the five orthopaedic departments of our university hospital to collect data on the surgeons (age, sex, years of experience), their practice (type of implants used, annual number of arthroplasties with each arthroplasty type and each indication, and proportion of cemented arthroplasties), the type of cement used, and the cementing technique.
Of the 34 surgeons, 21 completed the questionnaire, 20 males and 1 female with a mean age of 41 years (range, 31-59 years) and a mean of 11 years (range, 1-29 years) of experience. High-viscosity antibiotic-loaded cement was preferred by 20 (95%) surgeons, notably for knee arthroplasties, of which the median annual numbers were 55 (range, 0-218) and 8 (range, 1-40) for primary and revision cemented procedures, respectively. Various cementing techniques in ambient air were used: 12/21 (57%) surgeons used pulsed lavage to prepare the bone before cementation and 18/21 (86%) applied the cement to both the bone cuts and the implant. Of the 18 surgeons who performed knee arthroplasties, 12 used pulsed lavage, including 9 of the 11 surgeons with more than 5 years of experience and only 3 of the 7 less experienced surgeons. Similarly, of the 12 surgeons who used pulsed lavage for cemented arthroplasties, 11 were among the 12 surgeons who performed more than 15 cemented arthroplasties annually and 1 was among the 6 who performed fewer cemented arthroplasties.
Cementing techniques varied widely, reflecting the dearth of recommendations and controversial results of published studies. In our centre, the use of pulsed lavage to improve bone preparation and cement application to both the bone and the implant should be promoted, as both techniques are universally advocated. Our study demonstrates the need to provide surgeons with opportunities to exchange their experiences about the other aspects of cementing in order to harmonise practices and to optimise the use of cement.
IV, questionnaire survey.
尽管骨水泥在关节置换手术中广泛使用，但关于其最佳使用方式的建议却很少，然而这些方式却决定着长期的手术效果。目前尚无关于法国医院如何使用骨水泥的详细信息。在法国一家多中心大学医院对外科医生进行此次问卷调查的目的是描述实际操作情况，确定这些操作是否因外科医生的经验而异，并与相关建议进行对比以寻找差异。
在一家大学医院中，不同外科医生的骨水泥固定技术差异很大。
向我校医院的五个骨科科室发放了一份问卷，以收集有关外科医生（年龄、性别、经验年限）、他们的操作情况（使用的植入物类型、每种关节置换类型及每种适应症的年度关节置换手术数量，以及骨水泥固定关节置换手术的比例）、所用骨水泥的类型以及骨水泥固定技术的数据。
34名外科医生中，21名完成了问卷，其中20名男性和1名女性，平均年龄41岁（范围31 - 59岁），平均经验年限11年（范围1 - 29年）。20名（95%）外科医生更倾向于使用高粘度含抗生素骨水泥，尤其是在膝关节置换手术中，其中初次和翻修骨水泥固定手术的年度中位数分别为55例（范围0 - 218例）和8例（范围1 - 40例）。在常温空气中使用了各种骨水泥固定技术：12/21（57%）的外科医生在骨水泥固定前使用脉冲冲洗来处理骨面，18/21（86%）的医生将骨水泥应用于骨切面和植入物。在进行膝关节置换手术的18名外科医生中，12名使用了脉冲冲洗，其中11名经验超过5年的外科医生中有9名使用，而7名经验较少的外科医生中只有3名使用。同样，在12名对骨水泥固定关节置换手术使用脉冲冲洗的外科医生中，11名是每年进行超过15例骨水泥固定手术的12名医生中的，1名是每年进行骨水泥固定手术较少的6名医生中的。
骨水泥固定技术差异很大，这反映出相关建议的匮乏以及已发表研究结果的争议性。在我们中心，应推广使用脉冲冲洗以改善骨面处理，并将骨水泥应用于骨面和植入物，因为这两种技术都得到了普遍提倡。我们的研究表明，有必要为外科医生提供交流骨水泥固定其他方面经验的机会，以统一操作并优化骨水泥的使用。
IV，问卷调查。
