From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Acad Orthop Surg. 2022 Feb 1;30(3):e375-e383. doi: 10.5435/JAAOS-D-21-00553.
Bone cement implantation syndrome (BCIS) occurs during and after cementation of implants and is associated with hypotension, hypoxia, and cardiovascular collapse. In this study, we aimed to identify risk factors and potential mitigating factors of BCIS in the oncologic adult cohort undergoing cemented arthroplasty.
We retrospectively reviewed oncologic patients aged 18 years or older who underwent cemented arthroplasty of either the hip or knee from 2015 to 2020. All implants were stemmed. We classified BCIS into three separate categories: (1) grade 1: intraoperative moderate hypoxia (<94%) or drop in systolic blood pressure >20%; (2) grade 2: intraoperative severe hypoxia or drop in systolic blood pressure >40%; and (3) grade 3: cardiovascular collapse requiring cardiopulmonary resuscitation. Demographics, primary malignancy diagnosis, intraoperative factors including cement timing, development of BCIS, 30-day postoperative outcomes, and mortality up to 2 years postoperatively were evaluated. Bivariate analyses and multivariate logistic regression were performed.
Sixty-seven patients met inclusion criteria. Of these, 31 patients (46%) developed BCIS. No difference was found in age (65.5 versus 60.9 years; P = 0.15) or body mass index (28.8 kg/m2 versus 29.3 kg/m2; P = 0.76), comorbidities, intraoperative factors, or postoperative surgical outcomes between those who developed BCIS and those who did not (all; P > 0.05). An association with the type of anesthesia administered and development of BCIS in patients receiving general anesthesia alone (17/24 patients, 71%), neuraxial and general (4/15 patients, 27%), and regional and general anesthesia (10/28 patients 36%, P = 0.01) was found. Compared With neuraxial and regional anesthesia, general anesthesia alone had 5.8 (P = 0.007) and 4.5 times (P = 0.006) greater odds of developing BCIS, respectively. No differences were noted in rates of BCIS between regional and neuraxial anesthesia (P = 0.81).
Addition of regional or neuraxial anesthesia may be protective in reducing development of BCIS in the orthopaedic oncologic cohort undergoing hip and knee arthroplasty.
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骨水泥植入综合征（BCIS）发生在植入物固定过程中和之后，与低血压、缺氧和心血管崩溃有关。在这项研究中，我们旨在确定接受骨水泥关节置换术的成年肿瘤患者中 BCIS 的危险因素和潜在缓解因素。
我们回顾性分析了 2015 年至 2020 年期间接受髋关节或膝关节骨水泥关节置换术的年龄在 18 岁或以上的肿瘤患者。所有植入物均有柄。我们将 BCIS 分为三个单独的类别：（1）1 级：术中中度缺氧（<94%）或收缩压下降>20%；（2）2 级：术中严重缺氧或收缩压下降>40%；和（3）3 级：需要心肺复苏的心血管崩溃。评估了人口统计学资料、主要恶性肿瘤诊断、术中因素（包括骨水泥时机）、BCIS 的发展、30 天术后结果以及术后 2 年内的死亡率。进行了双变量分析和多变量逻辑回归。
67 名患者符合纳入标准。其中，31 名患者（46%）发生了 BCIS。在年龄（65.5 岁与 60.9 岁；P=0.15）或体重指数（28.8kg/m2 与 29.3kg/m2；P=0.76）、合并症、术中因素或术后手术结果方面，发生 BCIS 与未发生 BCIS 的患者之间没有差异（均；P>0.05）。在接受全身麻醉的患者中，与麻醉类型相关的与 BCIS 发生的关联为单独使用全身麻醉（24 例患者中的 17 例，71%）、神经轴和全身麻醉（15 例患者中的 4 例，27%）和区域和全身麻醉（28 例患者中的 10 例，36%，P=0.01）。与神经轴和区域麻醉相比，单独使用全身麻醉发生 BCIS 的几率分别高出 5.8 倍（P=0.007）和 4.5 倍（P=0.006）。区域和神经轴麻醉之间的 BCIS 发生率无差异（P=0.81）。
在接受髋关节和膝关节置换术的骨科肿瘤患者中，添加区域或神经轴麻醉可能有助于预防 BCIS 的发生。
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