中国髋关节置换术中骨水泥使用状况调查

Survey of current cement application by Chinese orthopedic surgeons

目的通过对关节外科医师的调查,了解中国国内髋关节置换术中骨水泥的使用现状。方法 2009年8月～10月间通过信函方式向中国大陆地区30个省、自治区和直辖市共1016名从事人工关节置换的医师发出调查问卷。问卷分6个部分:(1)医师个人信息;(2)置换数量;(3)使用骨水泥基本情况;(4)初次置换中第三代骨水泥技术的应用;(5)骨水泥安全性;(6)抗生素骨水泥使用。总计21个问题。2010年2月前寄回的问卷,除外无效回复,其余均纳入统计分析。结果规定时间内共收回726份问卷,其中632份为有效回复,有效回复率62%。94%的被调查医师从事关节外科,同时从事创伤和脊柱专业的占58%和49%。65%的医师年均髋关节置换量少于40例;35%的医师使用骨水泥型髋关节置换比例占40%以上;69%的医师使用进口骨水泥,但分别有31%和41%的医师不清楚所使用骨水泥品牌和粘度。骨水泥枪、股骨远端塞、股骨柄中置器、脉冲冲洗的使用率分别为91%、79%、62%、46%。骨水泥加压措施使用率均低于20%。8%的医师曾遭遇1次以上骨水泥型髋关节置换患者术中死亡。12%的医师在初次髋关节置换中常规使用抗生素骨水泥。结论骨水泥型髋关节置换依然在国内被广泛采用,但在骨水泥具体操作使用方面存在较大差异和不足。需要加强骨水泥及相关技术的规范和教育。

Objective To evaluate the current situation of cement using in Chinese mainland hip arthroplasty. Methods A questionnaire was posted to 1016 surgeons of 30 provinces in Chinese mainland. It was composed of six parts about 21 questions, regarding： （1） Practice characteristic of adult reconstructive orthopedic surgeon; （2） Patient care volume of hospital and surgeon; （3） Type of cement; （4） Third generation techniques; （5） Safety; （6） Usage of antibiotics in bone-cement. All the personal informations of orthopedic surgeons were obtained from their hospitals’ web sites. The surgeons who passed the following three criteria were included in this survey： （1） Performing hip arthroplasty was introduced in his resume; （2） Working in third level hospital; （3） No more than three surgeons in the same hospital were included. Results A total of 726 surgeons responded to the survey and 632 surgeons passed the fail-edit. 94% of the respondents characterized themselves as being adult joint reconstructive orthopedists. 58% and 49% of them identified themselves as having trauma or spine specialties at the same time. 65% of the surgeons performed hip arthroplasty less than 40 cases per year and only 35% stated that they used cement hip more than 40%. Of the surgeons, 69% used imported cement as usual, 31% and 41% did not know the brand and the viscosity of the cement they used. Cement gun, femur plug, femur centralizer and pulse lavage were used 91%, 79%, 62% and 46%, respectively. Less than 20% of the surgeons used ＂modern pressure＂ cementing techniques. 46% of surgeons concerned about the safety of cement. Antibiotic bone cement was regularly used by 12% of the respondents in their primary practice. Conclusion This survey revealed the wide diversity of cement use and inappropriate usage of ＂modern＂ cementing techniques in the primary total hip arthroplasty in China mainland. Educational dissemination to reduce practice variation and improve cementing techniques would be indicated.