[Delayed hypoxia after the surgical correction of femoral neck fracture].
We investigated perioperative blood gas changes in 26 patients scheduled for surgical correction of femoral neck fracture under epidural anesthesia. Arterial blood gases during spontaneous air respiration were measured eight times during the femoral neck prosthetic replacements (n = 16), and four times during osteosynthesis (n = 10). In the patients who received femoral neck replacements using bone cement (n = 8), arterial oxygen tension decreased significantly four hours after insertion of prosthesis, and did not recover during two postoperative days. In contrast, in the patients who received cementless femoral neck replacements (n = 8), arterial oxygen tension tended to decrease but not significantly, and returned to normal on the second postoperative day. In the patients who received osteosynthesis, arterial oxygen tension did not change. We suspected that the causes of delayed hypoxia in the femoral neck replacements were vascular endothelial cell injury in the lung by free fatty acid originating from fat embolism, and/or microthrombosis resulting from activated coagulation system. Bone cement was thought to intensify fat embolism because of elevated intramedullary pressure in the femur.
Goh
R
R
Department of Anesthesiology, Komatsushima Red Cross Hospital.
Mori
K
K
Abe
T
T
Kohyama
A
A
Minato
A
A
D000368:Aged; D000767:Anesthesia, Epidural; D001843:Bone Cements; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications
D001843:Bone Cements