股骨转移性骨病使用骨水泥型假体患者的骨水泥植入综合征
Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur.
作者信息
Ladegaard Thea Hovgaard, Stensballe Jakob, Petersen Michael Mørk, Sørensen Michala Skovlund
机构信息
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark.
Department of Anesthesiology, Surgery and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark.
出版信息
J Bone Oncol. 2025 Mar 26;52:100677. doi: 10.1016/j.jbo.2025.100677. eCollection 2025 Jun.
BACKGROUND
Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol.
METHODS
We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 - 2018 (early cohort) and 2019 - 2020 (late cohort) and stratified before and after the intervention.
RESULTS
Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03).
CONCLUSIONS
BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.
背景
股骨骨转移患者（BMf）可能会发生病理性骨折，需要使用骨水泥型内置假体（EPR）进行手术。在骨水泥注入和假体植入过程中，患者有发生缺氧、低血压、心力衰竭甚至死亡的风险，即骨水泥植入综合征（BCIS）。我们旨在：1）调查接受骨水泥型EPR治疗的BMf患者中BCIS的发生率和分级；2）检查在改变联合麻醉和手术方案后，BCIS的发生率或严重程度是否有所降低。
方法
我们回顾性评估了在2017 - 2018年（早期队列）和2019 - 2020年（晚期队列）两个时间段接受骨水泥型EPR手术的BMf患者，并在干预前后进行分层。
结果
比较早期和晚期队列，发生BCIS的患者分别为26/86（32%）和30/80（35%），但轻度BCIS（0 + 1级）的发生率分别为79%和86%，重度BCIS（2 + 3级）的发生率分别为21%和14%。在晚期队列中，术中血管加压药的使用比例更高（86%对59%，p < 0.001），我们发现肺栓塞（PE）的发生率更低（p = 0.024），且住院时间（LOS）有缩短的趋势。0 + 1级患者的30天生存率低于2 + 3级患者（p = 0.03）。
结论
超过1/3接受骨水泥型EPR治疗BMf的患者会发生BCIS。对BCIS加强多学科关注可能会减少BCIS的并发症，如PE和LOS。
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