Bone and soft tissue sarcomas, tumors of the skinBone and soft tissue sarcomas, tumors of the skinСаркомы костей, мягких тканей и опухоли кожи2219-46142782-3687Publishing House ABV Press433BONE SARCOMASСАРКОМЫ КОСТЕЙBone cement implantation syndrome during joint replacement in oncological patientsСиндром имплантации костного цемента при эндопротезировании крупных суставов у онкологических больныхGaryaevR. V.ГаряевР. В.
Russian Federation

Moscow

г. Москва

romvga@mail.ruSokolovskyA. V.СоколовскийА. В.
Russian Federation

Moscow

г. Москва

RychkovI. A.РычковИ. А.
Russian Federation

Moscow

г. Москва

N.N. Blokhin Russian Cancer Research CenterФГБНУ «Российский онкологический научный центр им. Н.Н. Блохина»23012015718162301202223012022Copyright ©; 2015, Garyaev R.V., Sokolovsky A.V., Rychkov I.A.Copyright ©; 2015, Гаряев Р.В., Соколовский А.В., Рычков И.А.2015Garyaev R.V., Sokolovsky A.V., Rychkov I.A.Гаряев Р.В., Соколовский А.В., Рычков И.А.https://creativecommons.org/licenses/by/4.0https://sarbon.abvpress.ru/jour/article/view/433

Methods. We performed a prospective study incidence, risk factors and haemodynamic effects associated with bone cement implantation syndrome (BSIS) at 211 oncological patients undergoing cemented joint replacement: total hip (30), knee (141), ankle (6), femur (9), elbow (3), hemischoulder (22) arthroplasty. The anesthetic technique consisted of superficial general or spinal anesthesia with epidural or conductive analgesia. The cardiovascular changes were determined. Multivariate logistic regression analysis was conducted to determine which clinical variables were predictive of BCIS.Results. The incidence of BCIS was 7.8% (11/141), 3.3% (1/30), 0% (0/22) among patients undergoing knee, hip and shoulder arthroplasty accordingly; intraoperative mortality was 0% (0/211). Independed patient-related risk factors have been implicated in the genesis of BCIS including old age, body mass index. There were three cases of BCIS during knee arthroplasty with inflated tourniquet.Conclusion. The cardiovascular indicators during cemented period could significantly increase that means cardiovascular reserves preservation.

Цель исследования. Определить частоту и факторы риска возникновения синдрома имплантации костного цемента при эндопротезировании крупных суставов у онкологических больных, а также выявить закономерности изменения гемодинамики.Материалы и методы. В проспективном исследовании 211 больным по поводу первичных злокачественных и метастатических опухолей костей выполнены операции в объеме удаления опухоли с последующим замещением дефекта мегапротезом тазобедренного (30), коленного (141), голеностопного (6), локтевого суставов (3), тотальным эндопротезом бедренной кости (9), однополюсным эндопротезом плечевого сустава (22). Для обезболивания применяли сочетание поверхностной общей или спинальной анестезии с эпидуральной или проводниковой анальгезией. Изучали показатели центральной и периферической гемодинамики на этапе цементирования эндопротеза. С помощью многофакторного логистического регрессионного анализа выявляли предикторы возникновения данного осложнения.Результаты. Частота синдрома имплантации костного цемента при эндопротезировании коленного сустава (после резекции бедренной и/или большеберцовой кости) составила 7,8% (11/141), тазобедренного – 3,3% (1/30), плечевого – 0% (0/22), связанная с данным осложнением летальность 0% (0/211). Независимыми факторами риска были старший возраст и избыточная масса тела пациента: с увеличением возраста на 1 год риск увеличивался на 5,8%, с повышением индекса массы тела на 1 кг/м2 – на 13%. Пневмотурникет, наложенный на верхнюю треть бедра при сегментарной резекции бедренной и большеберцовой кости с эндопротезированием коленного сустава, не мог полностью предотвратить развитие синдрома имплантации костного цемента.Вывод. При выбранных способах обезболивания резервы сердечно-сосудистой системы на этапе цементирования оставались сохраненными.

bone cement implantation syndromeсиндром имплантации костного цемента1. Donaldson A.J., Thomson H.E., Harper N.J., Kenny N.W. Bone cement implantation syndrome. Brit. J. Anesth. 2009, v. 102, No. 1, p. 12-22.Donaldson A.J., Thomson H.E., Harper N.J., Kenny N.W. Bone cement implantation syndrome. Brit. J. Anesth. 2009, v. 102, No. 1, p. 12-22.2. Coventry M.B., BeckenbaughR.D., NolanD.R., IlstrupD.M. 2,012 total hip arthroplasties: a study of postoperative course and early complications. J. Bone Joint Surg. 1974, v. 56, p. 273-284.Coventry M.B., BeckenbaughR.D., NolanD.R., IlstrupD.M. 2,012 total hip arthroplasties: a study of postoperative course and early complications. J. Bone Joint Surg. 1974, v. 56, p. 273-284.3. Ereth M.H., Weber J.G., Abel M.D. et al. Cemented versus noncemented total hip arthroplasty-embolism, haemodynamics and intrapulmonary shunting. Mayo Clinic Proc. 1992, v. 67, p. 1066-1074.Ereth M.H., Weber J.G., Abel M.D. et al. Cemented versus noncemented total hip arthroplasty-embolism, haemodynamics and intrapulmonary shunting. Mayo Clinic Proc. 1992, v. 67, p. 1066-1074.4. Parvizi J., HollidayA.D., Ereth M.H., Lewallen D.G. Sudden death during primary hip arthroplasty. Clin. Orthop. Relat. Res. 1999, v. 369, p. 39-48.Parvizi J., HollidayA.D., Ereth M.H., Lewallen D.G. Sudden death during primary hip arthroplasty. Clin. Orthop. Relat. Res. 1999, v. 369, p. 39-48.5. Мамаева Е.Г., Лебединский К.М., Машков В.М. и соавт. Синдром имплантации костного цемента при эндопротезировании тазобедренного сустава. СПб.: СПбМАПО. 2009, 116 с.Мамаева Е.Г., Лебединский К.М., Машков В.М. и соавт. Синдром имплантации костного цемента при эндопротезировании тазобедренного сустава. СПб.: СПбМАПО. 2009, 116 с.6. Byrick R.J., ForbesD., Waddell J.P. A monitored cardiovascular collapse during cemented total knee replacement. Anesthesiology. 1986, v. 65, p. 213-216.Byrick R.J., ForbesD., Waddell J.P. A monitored cardiovascular collapse during cemented total knee replacement. Anesthesiology. 1986, v. 65, p. 213-216.7. Govil P., KakarP.N., Arora D. et al. Bone cement implantation syndrome: a report of four cases. Indian J. Anaesth. 2009, v. 53, No. 2, p. 214-218.Govil P., KakarP.N., Arora D. et al. Bone cement implantation syndrome: a report of four cases. Indian J. Anaesth. 2009, v. 53, No. 2, p. 214-218.8. Orsini E.C., Richards R.R., Mullen J.M. Fatal fat embolism during cemented total knee arthroplasty: a case report. Can. J. Surg. 1986, v. 29, p. 385-386.Orsini E.C., Richards R.R., Mullen J.M. Fatal fat embolism during cemented total knee arthroplasty: a case report. Can. J. Surg. 1986, v. 29, p. 385-386.9. Lafont N.D., Kalonji M.K., Barre J. et al. Clinical features and echocardiography of embolism during cemented hip arthroplasty. Can. J. Anesth. 1997, v. 44, p. 112-117.Lafont N.D., Kalonji M.K., Barre J. et al. Clinical features and echocardiography of embolism during cemented hip arthroplasty. Can. J. Anesth. 1997, v. 44, p. 112-117.10. Herrenbruck T., Erickson E.W., Damron T.A., Heiner J. Adverse clinical events during cemented long-stem femoral arthroplasty. Clin. Orthop. Relat. Res. 2002, v. 395, p. 154-163.Herrenbruck T., Erickson E.W., Damron T.A., Heiner J. Adverse clinical events during cemented long-stem femoral arthroplasty. Clin. Orthop. Relat. Res. 2002, v. 395, p. 154-163.11. Karlsson J., Wendling W., Chen D. et al. Methylmethacrylate monomer produces direct relaxation of vascular smooth muscle in vitro. Acta Anaesthesiol. Scand. 1995, v. 39, p. 685-689.Karlsson J., Wendling W., Chen D. et al. Methylmethacrylate monomer produces direct relaxation of vascular smooth muscle in vitro. Acta Anaesthesiol. Scand. 1995, v. 39, p. 685-689.12. Peebles D.J., Ellis R.H., Stride S.D.K., Simpson B.R.J. Cardiovascular effects of methylmethacrylate cement. Br. Med. J. 1972, v. 1, p. 349-351.Peebles D.J., Ellis R.H., Stride S.D.K., Simpson B.R.J. Cardiovascular effects of methylmethacrylate cement. Br. Med. J. 1972, v. 1, p. 349-351.13. McLaughlin R.E., DiFazio C.A., Hakala M. et al. Blood clearance and acute pulmonary toxicity of methylmethacrylate in dogs after simulated arthroplasty and intravenous injection. J. Bone Joint Surg. 1973, v. 55, p. 1621-1628.McLaughlin R.E., DiFazio C.A., Hakala M. et al. Blood clearance and acute pulmonary toxicity of methylmethacrylate in dogs after simulated arthroplasty and intravenous injection. J. Bone Joint Surg. 1973, v. 55, p. 1621-1628.14. Modig J., Busch C., Olerud S. et al. Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers. Acta Anaesthesiol. Scand. 1975, v. 19, p. 28-43.Modig J., Busch C., Olerud S. et al. Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers. Acta Anaesthesiol. Scand. 1975, v. 19, p. 28-43.15. Modig J., Busch C., Waernbaum G. Effects of graded infusion of monomethylmethacrylate on coagulation, blood lipids, respiration and circulation. Clin. Orthop. Relat. Res. 1975, v. 113, p. 187-195.Modig J., Busch C., Waernbaum G. Effects of graded infusion of monomethylmethacrylate on coagulation, blood lipids, respiration and circulation. Clin. Orthop. Relat. Res. 1975, v. 113, p. 187-195.16. Orsini E.C., ByrickR.J., MullenJ.B.M. et al. Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components the role of intramedullary pressure. J. Bone Joint Surg. 1987, v. 69, p. 822-832.Orsini E.C., ByrickR.J., MullenJ.B.M. et al. Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components the role of intramedullary pressure. J. Bone Joint Surg. 1987, v. 69, p. 822-832.17. McCaskie A.W., Barnes M.R., Lin E. et al. Cement pressurization during hip replacement. J. Bone Joint Surg. (Br.). 1997, v. 79, p. 379-384.McCaskie A.W., Barnes M.R., Lin E. et al. Cement pressurization during hip replacement. J. Bone Joint Surg. (Br.). 1997, v. 79, p. 379-384.18. Edmonds C.R., Barbut D., Hager D., Sharrock N.E. Intraoperative cerebral arterial embolisation during total hip arthroplasty. Anesthesiology. 2000, v. 93, p. 315-318.Edmonds C.R., Barbut D., Hager D., Sharrock N.E. Intraoperative cerebral arterial embolisation during total hip arthroplasty. Anesthesiology. 2000, v. 93, p. 315-318.19. Sevitt S. Fat embolism in patients with fractured hips. Br. Med. J. 1972, v. 2, p. 257-262.Sevitt S. Fat embolism in patients with fractured hips. Br. Med. J. 1972, v. 2, p. 257-262.20. Byrick R.J. Cement implantation syndrome: a time limited embolic phenomenon. Can. J. Anaest. 1997, v. 44, No. 2, p. 107-111.Byrick R.J. Cement implantation syndrome: a time limited embolic phenomenon. Can. J. Anaest. 1997, v. 44, No. 2, p. 107-111.21. Gammer W., Bengtson A., Heideman M. Inhibition of complement activation by high-dose corticosteriods in total hip arthroplasty. Clin. Orthop. Relat. Res. 1998, v. 236, p. 205-209.Gammer W., Bengtson A., Heideman M. Inhibition of complement activation by high-dose corticosteriods in total hip arthroplasty. Clin. Orthop. Relat. Res. 1998, v. 236, p. 205-209.22. Wheelwright E.F., Byrick R.J., Wigglesworth D.F. et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J. Bone Joint Surg. 1993, v. 75, p. 715-723.Wheelwright E.F., Byrick R.J., Wigglesworth D.F. et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J. Bone Joint Surg. 1993, v. 75, p. 715-723.23. Hayakawa M., Fujioka Y., Morimoto Y. et al. Pathological evaluation of venous emboli during total hip arthroplasty. Anaesthesia. 2001, v. 56, p. 571-575.Hayakawa M., Fujioka Y., Morimoto Y. et al. Pathological evaluation of venous emboli during total hip arthroplasty. Anaesthesia. 2001, v. 56, p. 571-575.24. Werner L. A response to «Sudden deaths during hip hemiarthroplasty». Anaesthesia. 2003, v. 58, p. 922-923.Werner L. A response to «Sudden deaths during hip hemiarthroplasty». Anaesthesia. 2003, v. 58, p. 922-923.25. Lamade W.R., Friedl W., SchmidB., Meeder P.J. Bone cement implantation syndrome. A prospective randomised trial for the use of antihistamine blockade. Arch. Orthop. Trauma Surg. 1995, v. 114, p. 335-339.Lamade W.R., Friedl W., SchmidB., Meeder P.J. Bone cement implantation syndrome. A prospective randomised trial for the use of antihistamine blockade. Arch. Orthop. Trauma Surg. 1995, v. 114, p. 335-339.26. Mitsuhata H., Saitoh J., Saitoh K. Methylmethacrylate bone cement does not release histamine in patients undergoing prosthetic replacement of femoral head. Br. J. Anaesth. 1994, v. 73, p. 779-781.Mitsuhata H., Saitoh J., Saitoh K. Methylmethacrylate bone cement does not release histamine in patients undergoing prosthetic replacement of femoral head. Br. J. Anaesth. 1994, v. 73, p. 779-781.