Hôpital Franco-Britannique, 4, rue Kléber, 92300 Levallois-Perret, France.
Clinique de l'Yvette, 67, route de Corbeil, 91160 Longjumeau, France.
Orthop Traumatol Surg Res. 2022 Apr;108(2):103139. doi: 10.1016/j.otsr.2021.103139. Epub 2021 Nov 8.
Cemented femoral implants incur a serious risk of potentially fatal accidents in case of bone cement implantation syndrome (BCIS). As French data are sparse regarding this issue, Orthorisq, the official accreditation body for orthopedic surgeons, conducted an inter-professional survey: 1) to assess the frequency of BCIS, 2) to analyze risk factors related to the patient and to professional practices, and 3) to set out guidelines to reduce frequency and/or severity.
French data on BCIS are underestimated and need updating to ease communication between colleagues.
In 2019, Orthorisq ran a survey of its members' practices and a "mirror" survey of anesthesiologists. In the decade from 2009 to 2018, the 775 respondent orthopedic surgeons, both occasional and systematic "cementers", reported their experience with a declared annual rate of 80,112 arthroplasties, including 63,799 (79.6%) in scheduled surgery. Some of the survey questions concerned cementing technique. With the help of the French College of Anesthesia and Intensive Care Medicine, 305 anesthesiologists responded to the mirror survey.
The 776 orthopedic surgeons reported 1896 cementing accidents with 387 deaths during the study decade. Accidents were 6-fold more frequent in traumatology than in scheduled orthopedic surgery (0.71% versus 0.12%) and, more importantly, were more serious: mortality was 10-fold higher (0.17% versus 0.017% [p<0.001]). Certain "tricks and tips" intended to improve cementing quality, such as a dedicated system and especially a plug, significantly increased the risk of BCIS (p<0.001). Over the same period, the 305 anesthesiologists had been involved in 490 cementing accidents; 88 (29%) had been faced by at least 1 death, most often in emergency settings (60/28). While 753 surgeons (96%) reported warning the anesthetists and 571 (74%) waited for agreement before cementing, only 109 (36%) and 124 (41%) anesthetists reported being systematically alerted to cementing and implant reduction, respectively. The rate of serious accidents was 0.19% and mortality was 0.05%, for a cumulative probability of 0.24% per year. Extrapolated to the data of the ATIH Technical Agency of Hospitalization Information and subtracting arthroplasties by "never-cementers", these figures indicate 311 accidents with 65 deaths in femoral BCIS for 2018.
In scheduled surgery, BCIS was exceptional, but the rate in traumatology was much higher. Certain techniques intended to improve femoral cementing quality actually increased the risk of BCIS; in high-risk patients, especially in traumatology, non-cemented femoral implants or else a 1st-generation cementing technique should therefore be preferred. Prevention of BCIS and/or reduction of severity require identification of at-risk patients and good communication between surgeons and anesthesiologists, especially at the various steps of the checklist.
IV; case series.
在发生骨水泥植入综合征（BCIS）的情况下，骨水泥固定的股骨植入物存在严重的潜在致命事故风险。由于法国在这个问题上的数据很少，法国矫形外科医师认证机构 Orthorisq 进行了一项跨专业调查：1）评估 BCIS 的频率，2）分析与患者和专业实践相关的风险因素，3）制定降低频率和/或严重程度的指南。
法国关于 BCIS 的数据被低估了，需要更新，以方便同事之间的沟通。
2019 年，Orthorisq 对其成员的实践进行了调查，并对麻醉师进行了“镜像”调查。在 2009 年至 2018 年的十年间，775 名骨科医生（偶尔和系统的“水泥工”）报告了他们的经验，他们报告的年度关节置换术的估计发生率为 80,112 例，其中 63,799 例（79.6%）是择期手术。一些调查问题涉及到水泥固定技术。在法国麻醉与重症监护医学学院的帮助下，305 名麻醉师对镜像调查做出了回应。
776 名骨科医生报告了 1896 例水泥固定事故，其中 387 例死亡。在研究期间，创伤科的事故发生率是计划性骨科手术的 6 倍（0.71%比 0.12%），更重要的是，情况更严重：死亡率高 10 倍（0.17%比 0.017%[p<0.001]）。某些旨在提高水泥质量的“技巧和窍门”，如专用系统，特别是塞子，显著增加了 BCIS 的风险（p<0.001）。同期，305 名麻醉师共参与了 490 例水泥固定事故；88 例（29%）至少有 1 例死亡，多数情况下是在紧急情况下（60/28）。虽然 753 名外科医生（96%）报告了警告麻醉师的情况，571 名（74%）在水泥固定前等待同意，但只有 109 名（36%）和 124 名（41%）麻醉师分别报告系统地接到了水泥固定和植入物减少的通知。严重事故的发生率为 0.19%，死亡率为 0.05%，每年累积概率为 0.24%。根据法国 ATIH 技术机构的住院信息推算，减去从不使用水泥的患者的关节置换术，这些数据表明 2018 年在股骨 BCIS 中有 311 例事故和 65 例死亡。
在计划性手术中，BCIS 很罕见，但在创伤科的发生率要高得多。某些旨在提高股骨水泥固定质量的技术实际上增加了 BCIS 的风险；在高危患者中，尤其是在创伤科，应优先选择非骨水泥股骨植入物或第一代水泥固定技术。预防 BCIS 和/或降低严重程度需要识别高危患者，并在外科医生和麻醉师之间进行良好的沟通，特别是在检查表的各个步骤。
IV；病例系列。
