Kaidi Austin C, Held Michael B, Boddapati Venkat, Trofa David P, Neuwirth Alexander L
Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
Arthroplast Today. 2020 Jul 14;6(3):566-570. doi: 10.1016/j.artd.2020.07.006. eCollection 2020 Sep.
Expedited time to surgery after hip fracture is associated with decreased morbidity and mortality in appropriately optimized patients. However, the optimal timing of surgery in patients with the novel coronavirus disease 2019 (COVID-19) infection remains unknown. This case report describes a patient with COVID-19 pneumonia complicated by multiorgan system failure requiring intubation who sustained a femoral neck fracture that required total hip arthroplasty. This patient had a significant, deliberate delay in time to surgical intervention because of his critical state. When deciding the optimal timing for total hip arthroplasty in patients with COVID-19, we recommend using inflammatory markers, such as procalcitonin and interleukin-6, as indicators of disease resolution and caution operative intervention when patients are nearing the 7-10th day of COVID-19 symptoms. Furthermore, implant cementation and spinal anesthesia in critically ill COVID-positive patients should be approached cautiously in the setting of pulmonary disease and multiorgan system failure. Close follow-up with medical doctors is recommended to minimize long-term sequelae and delay to baseline mobility.
髋部骨折后加快手术时间与病情适当优化患者的发病率和死亡率降低相关。然而，2019年新型冠状病毒病（COVID-19）感染患者的最佳手术时机仍不清楚。本病例报告描述了一名患有COVID-19肺炎并伴有多器官系统衰竭需要插管的患者，该患者发生了股骨颈骨折，需要进行全髋关节置换术。由于其危急状态，该患者在手术干预时间上有显著的故意延迟。在决定COVID-19患者全髋关节置换术的最佳时机时，我们建议使用炎症标志物，如降钙素原和白细胞介素-6，作为疾病缓解的指标，并在患者接近COVID-19症状出现的第7至10天时谨慎进行手术干预。此外，在患有肺部疾病和多器官系统衰竭的情况下，对病情危重的COVID阳性患者进行植入物骨水泥固定和脊髓麻醉时应谨慎。建议与医生密切随访，以尽量减少长期后遗症并延迟恢复至基线活动能力。
