Zastrow Ryley K, Rao Sandesh S, Morris Carol D, Levin Adam S
From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Zastrow, Dr. Levin), Washington Orthopaedics and Sports Medicine, Washington, DC (Dr. Rao), and the Memorial Sloan Kettering Cancer Center, New York City, NY (Dr. Morris).
J Am Acad Orthop Surg. 2025 Jan 1;33(1):e46-e57. doi: 10.5435/JAAOS-D-24-00239. Epub 2024 Aug 30.
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and cardiovascular compromise during cementation in arthroplasty cases. This study examines the association between anesthetic regimen and risk of BCIS in cemented hemiarthroplasty for hip fractures. We hypothesized that neuraxial anesthesia would be associated with markedly lower BCIS incidence compared with general anesthesia alone or in combination with regional anesthesia.
This retrospective cohort study included patients aged 50 years or older who underwent cemented hemiarthroplasty for hip fractures at a single institution between January 2017 and December 2022. Patient demographics, comorbidities, procedural factors, anesthetic characteristics including anesthetic regimen (general, general plus regional, or neuraxial), cement timing, BCIS development, postoperative complications, and mortality data were extracted. BCIS was identified by changes in postcementation vitals and its severity classified according to previously established criteria. Univariate statistical analyses and multivariate logistic regression were conducted.
Of the 137 included patients, 58 (43%) developed BCIS. No notable differences were observed in demographics, comorbidities, or procedural characteristics between patients who developed BCIS and those who did not. However, anesthetic regimen was markedly correlated with BCIS development, with general anesthesia demonstrating the highest rates (26/43, 55%), followed by general plus regional anesthesia (26/58, 45%) and neuraxial anesthesia (6/32, 19%; P = 0.005). Compared with neuraxial anesthesia, general anesthesia and general plus regional anesthesia conferred 6.8 and 5.5 times greater odds of developing BCIS, respectively. The development of BCIS was associated with significantly higher rates of postoperative hypoxia ( P = 0.04) and unplanned prolonged intubation ( P = 0.04).
BCIS was highly prevalent among patients undergoing cemented hemiarthroplasty for hip fractures. The anesthetic regimen was the only variable markedly associated with BCIS development and is a potentially modifiable risk factor.
III.
骨水泥植入综合征（BCIS）的特征是在关节置换手术中骨水泥注入过程中出现缺氧、低血压和心血管功能障碍。本研究探讨了麻醉方案与髋部骨折骨水泥半髋关节置换术中BCIS风险之间的关联。我们假设与单纯全身麻醉或全身麻醉联合区域麻醉相比，神经轴索麻醉与显著更低的BCIS发生率相关。
这项回顾性队列研究纳入了2017年1月至2022年12月期间在单一机构接受髋部骨折骨水泥半髋关节置换术的50岁及以上患者。提取患者的人口统计学资料、合并症、手术因素、麻醉特征（包括麻醉方案：全身麻醉、全身麻醉加区域麻醉或神经轴索麻醉）、骨水泥注入时间、BCIS的发生情况、术后并发症及死亡率数据。通过骨水泥注入后生命体征的变化来确定BCIS，并根据先前制定的标准对其严重程度进行分类。进行单因素统计分析和多因素逻辑回归分析。
在纳入的137例患者中，58例（43%）发生了BCIS。发生BCIS的患者与未发生BCIS的患者在人口统计学资料、合并症或手术特征方面未观察到显著差异。然而，麻醉方案与BCIS的发生显著相关，全身麻醉的发生率最高（26/43，55%），其次是全身麻醉加区域麻醉（26/58，45%）和神经轴索麻醉（6/32，19%；P = 0.005）。与神经轴索麻醉相比，全身麻醉和全身麻醉加区域麻醉发生BCIS的几率分别高出6.8倍和5.5倍。BCIS的发生与术后缺氧（P = 0.04）和意外延长气管插管（P = 0.04）的发生率显著升高相关。
BCIS在接受髋部骨折骨水泥半髋关节置换术的患者中非常普遍。麻醉方案是唯一与BCIS发生显著相关的变量，是一个潜在的可改变的危险因素。
III级
