A Retrospective Study Of Bone Cement Implantation Syndrome In Femoral Head Replacement Of Femoral Neck Fracture In The Elderly

Objective : This study retrospectively analyzed the occurrence of bone cement implantation syndrome(BCIS)in patients with femoral neck fractures in the elderly,and graded the classification according to the patient data to further analyze the risk of severe BCIS and preventive measures in order to provide theoretical and practical reference for the treatment of femoral neck fracture in the elderly.Methods : To study the application of bone cement artificial femoral head replacement in the treatment of femoral neck fractures in the elderly between January 2013 and January2016 in Shaanxi Provincial People's Hospital.According to the study,the clinical data of196 patients were retrospectively analyzed,including 57 males and 139 females,aged80.36 ± 9.28 years.Using access to medical records,access to imaging materials,etc.to obtain the basic information of patients and according to the literature reported that the relevant indicators may be collected(Including age,sex,body mass index,associated disease and concomitant disease,ASA grade,timing of operation,anesthesia,preoperative D-dimer volume,preoperative hemoglobin,bone cement type,intraoperative blood loss,bone Whether the intravenous infusion of methylprednisolone before and after the application of cement and the use of dose and the use of bone filling time interval,the patient postoperative and related imaging data).Establish a database for the above indicators.According to the latest diagnostic criteria for the occurrence of BCIS and the occurrence of BCIS classification statistics,the literature shows that BCIS? patients with BCIS ? and ? patients compared with clinical manifestations are not obvious,low mortality.There were no cases of BCIS and BCIS ?,and BCIS ? and ?were divided into one class,which compared the differences between the two groups.SPSS18.0 software for statistical treatment,the aforementioned factors as an independent variable,the occurrence of BCIS severity(not occurred and BCIS ? patients with BCIS ? and ? patients)as the amount of strain,The single-factor analysis of the above indicators,the categorical variables using ?2 test or correction of ?2 test,continuous variables using T test,the test level is set to 0.05.Multivariate analysis was used to analyze the multivariate analysis statistically significant independent variables into the Logistic regression model,P <0.05 for the difference was statistically significant.Results:1.Among the 196 eligible patients,65 cases developed BCIS,the incidence was33.16%,of which ?,?,? were 22.96%,9.18%,1.02%.2 patients died with a mortality rate of 1.02%.2.Univariate analysis showed age(?85 years and <85 years),whether accompanied by disease(pulmonary hypertension,COPD,chronic heart failure),accompanied by the number of diseases(? 2 and ? 3).The difference of the five factors was statistically significant(P <0.05).3.Multivariate analysis showed that pulmonary hypertension,COPD,chronic heart failure,and disease(?3)were more likely to develop severe BCIS(P <0.05).4.Bone cement before implantation 30min(40 ~ 500mg)and not used methylprednisolone,BCIS on the contrast,the statistical significance(P <0.05).There was no statistically significant difference between the dose and the time of bone cement implantation in the use of BCIS(P <0.05).Conclusion :In this study,196 cases of femoral neck fractures of bone cement artificial femoral head replacement in elderly patients with clinical data were retrospectively analyzed,the main conclusions.1.BCIS is a common complication of bone cement artificial femoral head replacement in the elderly,the incidence of which is 33.16%,of which ?,?,? level were 22.96%,9.18%,1.02%.For patients with BCIS grade I,although there is no obvious clinical symptoms,but for the surgeon and anesthesiologist has a good warning.For such patients to give timely treatment measures,and close observation of patients with intraoperative and postoperative changes in the disease,to prevent further serious BCIS,critical life of patients.2.Accompanied by pulmonary hypertension,COPD,chronic heart failure,accompanied by the number of diseases(? 3)is a serious risk factor for the occurrence of severe BCIS.For patients with associated risk factors,orthopedic surgeons and anesthetists should have adequate risk-benefit comparisons for preoperative patients who undergo such surgery.3.During the first 30 minutes of bone cement implantation,intravenous infusion of methylprednisolone(40 ~ 500mg)had a preventive effect on the occurrence of BCIS.The results of this study can provide reference for the choice of femoral neck replacement in the practice of femoral neck fracture in clinical practice of joint surgery,which is of great theoretical and clinical significance for guiding operation and reducing postoperative complications.