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人工股骨头置换术中骨水泥心内渗漏:一例报告及文献复习

Intracardiac leakage of cement during artificial femoral head replacement: a case report and review.

作者信息

Li Jin, Zhang Yanqing, Zhang Hongmei, Jiang Shanyun, Wu Xindong

机构信息

Department of Anesthesiology, Kaihua County People's Hospital Quzhou 324300, Zhejiang, China.

Department of Clinical Trial Center, Kaihua County People's Hospital Quzhou 324300, Zhejiang, China.

出版信息

Int J Clin Exp Pathol. 2024 Mar 15;17(3):72-77. doi: 10.62347/FHAR9264. eCollection 2024.

Abstract

Bone cement leakage from the femoral medullary cavity is a rare complication following hip replacement. Currently, there are no reports of bone cement leakage into the heart. Here, we report an 81-year-old female patient with right femoral neck fracture. A thorough preoperative examination showed that bone cement had leaked into the heart during right femoral head replacement, leading to the death of the patient that night. Postoperative cardiac ultrasound showed that bone cement entered the vascular system through the femoral medullary cavity and subsequently entered the heart. Extreme deterioration in the patient's condition resulted in death that night. Unfortunately, the patient's family abandoned the idea of surgical removal of foreign bodies, leading to inevitable death. This case emphasizes the risk of clinical manifestations of cardiac embolism of bone cement after artificial femoral head replacement, suggesting that the risk of such embolism might be underestimated. We propose routine real-time C-arm X-ray guidance and injection of an appropriate amount of bone cement to prevent serious cardiopulmonary failure.

摘要

股骨骨髓腔内骨水泥渗漏是髋关节置换术后一种罕见的并发症。目前,尚无骨水泥渗漏至心脏的报道。在此,我们报告一例81岁女性右股骨颈骨折患者。术前全面检查显示,在右股骨头置换过程中骨水泥渗漏至心脏,导致患者于当晚死亡。术后心脏超声显示,骨水泥通过股骨髓腔进入血管系统,随后进入心脏。患者病情急剧恶化,于当晚死亡。遗憾的是,患者家属放弃了手术取出异物的想法,导致患者不可避免地死亡。本病例强调了人工股骨头置换术后骨水泥心脏栓塞临床表现的风险,提示这种栓塞风险可能被低估。我们建议常规采用实时C型臂X线引导并注入适量骨水泥,以预防严重心肺功能衰竭。

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本文引用的文献

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Femoral Neck Fracture with Avascular Necrosis.
J Nucl Med Technol. 2023 Mar;51(1):78-79. doi: 10.2967/jnmt.122.264354. Epub 2022 Aug 30.
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J Bone Joint Surg Am. 2022 Jun 1;104(11):1024-1033. doi: 10.2106/JBJS.21.00853. Epub 2022 Mar 17.
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Arthroplasties for hip fracture in adults.成人髋部骨折的关节成形术。
Cochrane Database Syst Rev. 2022 Feb 14;2(2):CD013410. doi: 10.1002/14651858.CD013410.pub2.
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