Life-Threatening Cardiovascular Collapse Complicated with Cemented Orthopedic Procedures

使用股水泥於骨科手術併發心臟血管衰竭

賴國良(Jiunn-Liang Lai) ； 楊俊佑(Chyun-Yu Yang) ； 林瑞模(Ruey-Mo Lin) ； 林啟禎(Chii-Jeng Lin) ； 劉鑑(Jain Liu) ； 賴國安(Kuo-An Lai)

《Journal of Orthopaedic Surgery Taiwan》 10卷2期 (1993/06) Pp. 219-233

摘要

六十九位病人接受使用骨水泥的骨科手術，其中九位病人發生心臟血管衰竭的併發症。經過急救後，其中五位病人存活，然而四位病人術後死亡。所有的這些心臟血管衰竭併發症發生在病理性股骨骨折接受骨水泥骨髓腔內鋼釘的病人，或股骨頸骨折接受骨水泥兩極式人工股骨頭置換術的病人。危險因子包括老年人，術前較差的心肺狀態，病理性骨折，骨質疏鬆，使用大量的骨水泥或骨水泥槍以進行骨髓腔管內加壓作用，未曾被擴鑽過的骨髓腔。在我們的報告中，發生心臟血管衰竭併發症的時間大部分是在將骨內鋼釘或兩極式人工股骨頭打入灌有骨水泥的骨髓腔後馬上發生，但可延遲到十分鐘後才發生。足夠的術前水分補給，手術中精細的生命徵象監視，隨時準備好的血液及增壓藥物以備不時之需，呼吸純氧以預防低血氧症，在骨髓腔管被擴鑽後使用大量的水清洗骨髓腔管內的雜質，這些是降低骨水泥心臟血管衰竭併發症發生的有效方法。

並列摘要

Nine cardiovascular collapse complications were encountered among sixty-nine patients receiving cemented orthopedic procedures. Four patients resulted in fatal outcome postoperatively while the others survived the episode without sequela after successful resuscitation. All the complications happened in either the patients receiving cemented intramedullary nail for pathological femoral fracture or cemented bipolar hemiarthroplasty for hip fracture. Risk factors are old age, poor cardiopulmonary compliance, pathological fracture, osteoporosis, large amount of cement, excessive pressurization with cement gun, and a previously undis-trubed intramedullary canal. The timing of onset of cardiovascular collapse most occurred immediately after impacting the implant into a cemented canal, but it might delay ten minutes as in our cases. Adequate preoperative fluid hydration, intensive hemodynamic monitoring, ready-prepared blood and vasopressor drugs, inspiration of 100 percent oxygen, and copious irrigation of marrow debris after reaming are useful prophylactic methods to lower the catastrophic complication during cementation.