Schuetze Konrad, Ehinger S, Eickhoff A, Dehner C, Gebhard F, Richter P H
Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Department of Anesthesiology, University Hospital Ulm, Ulm, Germany.
Arch Orthop Trauma Surg. 2021 May;141(5):803-811. doi: 10.1007/s00402-020-03531-2. Epub 2020 Jul 25.
Cement augmentation of the proximal femur nail antirotation (PFNA; Fa. DePuy Synthes) showed good biomechanical and clinical results regarding increased stability and functional outcome [Linden et al. in J Orthop Res 24:2230-2237, 2006;Kammerlander et al. in Injury 49:1436-1444, 2018;]. Cement-associated complications are well known in orthopedic procedures like hip arthroplasty, vertebra- and kyphoplasty. This study investigates outcome and safety of augmentation of the proximal femur nail blade.
The retrospective review of the 299 patients (mean age 80 ± 13 years; 205 women and 94 men) focused on perioperative complications after augmentation which was performed with Traumacem V+ Cement (Fa. DePuy Synthes) in 152 cases. The decision for augmentation of the blade was made by the attending surgeon and based on the factors age, bone quality, and fracture pattern. Primary outcome measures were changes in blood pressure, heart rate or oxygen saturation, and the number of needed vasoactive drugs during augmentation. Secondary outcome measures where the rate of cement leakage into the joint, mechanical failure, and perioperative complications like pulmonary embolism, stroke, or heart attack.
In 152 augmented cases, no leakage of cement into the joint could be detected. No signs of mechanical failure like cut-out of the blade were seen after 6 weeks and 3 months. Also, augmentation did not show a higher rate of mortality or postoperative complications like stroke, heart attack, embolism, or infection. 57 of 152 augmented cases received an intraoperative intervention with vasoactive medication at the time of augmentation either prophylactically or because of a blood pressure fall. Out of the non-augmented cases, 21 of 147 needed vasoactive medication in the second half of the operation. The difference between these groups was significant (p < 0.05). In the cases without an intervention, there was a significant blood pressure fall of about 8 ± 7.4 mmHg during the augmentation (p < 0.001). Still, none of the augmented cases showed a change in heart rate or oxygen saturation.
The augmentation of the PFNA blade proved to be a safe procedure. Cement augmentation will not increase postoperative complications or mortality. The risk for leakage of cement into the joint is low and mechanical cut-out might be prevented. The decision for augmentation should be made carefully and always be declared loud and in advance to allow the anesthetist to prepare, because blood pressure changes can occur.
股骨近端防旋髓内钉（PFNA；德普伊辛迪思公司）联合骨水泥增强术在增加稳定性和改善功能结局方面显示出良好的生物力学和临床效果[林登等人，《矫形外科学研究杂志》24:2230 - 2237，2006年；卡姆勒兰德等人，《损伤》49:1436 - 1444，2018年]。在髋关节置换术、椎体成形术和后凸成形术等骨科手术中，骨水泥相关并发症是众所周知的。本研究调查股骨近端髓内钉刀片增强术的疗效和安全性。
回顾性分析299例患者（平均年龄80±13岁；205例女性，94例男性），重点关注152例使用Traumacem V +骨水泥（德普伊辛迪思公司）进行增强术后的围手术期并发症。刀片增强的决定由主刀医生做出，基于年龄、骨质和骨折类型等因素。主要结局指标为增强过程中血压、心率或血氧饱和度的变化，以及增强过程中所需血管活性药物的数量。次要结局指标为骨水泥渗漏至关节的发生率、机械性失效以及围手术期并发症，如肺栓塞、中风或心脏病发作。
在152例增强病例中，未检测到骨水泥渗漏至关节。6周和3个月后未见刀片穿出等机械性失效迹象。此外，增强术并未显示出更高的死亡率或术后并发症，如中风、心脏病发作、栓塞或感染。152例增强病例中有57例在增强时接受了预防性或因血压下降而进行的术中血管活性药物干预。在未增强的病例中，147例中有21例在手术后半程需要血管活性药物。两组之间的差异具有统计学意义（p < 0.05）。在未进行干预的病例中，增强过程中血压显著下降约8±7.4 mmHg（p < 0.001）。不过，所有增强病例的心率或血氧饱和度均未出现变化。
PFNA刀片增强术被证明是一种安全的手术。骨水泥增强不会增加术后并发症或死亡率。骨水泥渗漏至关节的风险较低，且可预防机械性穿出。增强的决定应谨慎做出，并始终提前明确告知麻醉医生以便其做好准备，因为可能会发生血压变化。
