Adölesan idiyopatik skolyoz cerrahisinde cell saver kullanımının etkinliği

Year 2014, Volume: 48 Issue: 3, 303 - 306, 30.05.2014

Turgut Akgul Fatih Dikici Mehmet Ekinci Mehmet Buget Gokhan Polat Cuneyt Sar

https://doi.org/10.3944/AOTT.2014.13.0146

Abstract

Amaç:Bu çalışmanın amacı adölesan idiyopatik skolyoz hastalarının pedikül vidası ve rod kombinasyonu ile cerrahi tedavisinde otolog kan transfüzyonu cell saver yönteminin allojenik kan replasmanı üzerine etkisini araştırmaktı.

Çalışma planı: Adölesan idiyopatik skolyoz nedeniyle ameliyat edilen 33 hasta (5 erkek, 28 kadın) çalışmaya alındı. Cell saver kullanılan 16 hasta (ortalama yaş: 17.1±3.9; Grup A) ve kontrol amaçlı, cell saver kullanılmayan 17 hasta (ortalama yaş: 18.7±6.8; Grup B) olmak üzere iki grup oluşturuldu. Hastaların Cobb açıları, pedikül tespit seviyeleri, operasyon süreleri, operasyon sonrası drenajları, hemoglobin değişimleri, allojenik kan replasmanları ve otolog eritrosit miktarları kaydedildi.

Bulgular: Her iki grupta tespit edilen omur seviyeleri 12.9±1.54 (Grup A), 12.8±1.47 (Grup B) ve kullanılan vida sayıları 21.1±3.21 (Grup A), 18.7±3.59 (Grup B) idi (p>0.05). Ortalama ameliyat süresi 224 dakika, gruplara göre dağılımı 228±58 (Grup A), 221±60 (Grup B) dakika olarak kaydedildi. Demografik özellikler açısından iki grup arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0.05). Ameliyat öncesi iki grup arasındaki hemoglobin değerleri 12.2±1.47 mg/dl (Grup A) ve 13.1±1.56 mg/dl (Grup B) iken, operasyon sonrası hemoglobin değerleri ise 11.3±1.62 mg/dl (Grup A) ve 9.86±0.93 mg/dl (Grup B) olarak bulundu (p=0.004). Otolog eritrosit replasman miktarı 284±139 ml olarak kaydedildi. Operasyon sonrası birinci günde meydana gelen drenaj miktarı 834±253 ml (Grup A), 759±380 ml (Grup B) idi (p>0.05). Hastalara verilen toplam allojenik kan replasman miktarı 1.88±0.88 ünite (Grup A) ve 1.94±1.34 ünite (Grup B) olarak ölçüldü (p>0.05).

Çıkarımlar: Adölesan idiyopatik skolyozun cerrahi tedavisinde cell saver kullanımı ile otolog eritrosit transfüzyonu yapılabilmesine rağmen allojenik kan replasman miktarında anlamlı azalma sağlanamamaktadır.

Keywords

Adölesan idiyopatik skolyoz; allojenik kan replasmanı; cell saver; eritrosit replasmanı

The efficacy of cell saver method in the surgicaltreatment of adolescent idiopathic scoliosis

Abstract

Objective:The aim of the study was to evaluate the efficacy of the intraoperative blood salvage cell saver method for allogeneic blood transfusion in the surgical treatment of adolescent idiopathic scoliosis with pedicle screw and rod combination.

Methods: The study included 33 patients (5 males and 28 females) who underwent surgery due to adolescent idiopathic scoliosis. Patients were divided into 2 groups; 16 patients (mean age: 17.1±3.9 years) in Group A were operated using the cell saver (Medtronic Autolog; autologous cell saver machine) method and the 17 patients (mean age 18.7±6.8 years) in Group B (control group) were treated without cell saver. The Cobb angle, levels of pedicle fixation, operation time, postoperative bleeding, hemoglobin change, allogeneic blood replacement and the amount of autologous erythrocytes were recorded.

Results: Mean level of pedicle fixation was 12.9±1.54 vertebra using a mean of 21.1±3.21 screws in Group A and 12.8±1.47 vertebra using 18.7±3.59 screws in Group B (p>005). The mean operation time was 224 (Group A: 228±58; Group B: 221±60) minutes. There were no statistically significant differences in the demographic characteristics of both groups (p>0.05). The preoperative mean hemoglobin levels were 12.2±1.47 mg/dl in Group A and 13.1±1.56 mg/dl in Group B. Postoperative mean hemoglobin level was 11.3±1.62 mg/dl in Group A and 9.86±0.93 mg/dl in Group B (p=0.004). The mean amount of autologous erythrocyte replacement was 284±139 ml. The mean postoperative bleeding was 834±253 ml in Group A and 759±380 ml in Group B (p>0.05). The mean allogeneic blood replacement was 1.88±0.88 units in Group A and 1.94±1.34 in Group B (p>0.05).

Conclusion: Autologous erythrocyte replacement was possible using the cell saver method. However, there was no decrement in allogeneic blood replacement using cell saver in the surgical treatment of adolescent idiopathic scoliosis.

Keywords

Adolescent idiopathic scoliosis, allogeneic blood transfusion, cell saver, erythrocyte replacement

References

• Shapiro F, Sethna N. Blood loss in pediatric spine surgery. Eur Spine J 2004;13 Suppl 1:S6-17.
• Carey PA, Schoenfeld AJ, Cordill RD, Tompkins BJ, Caskey PM. A Comparison of Cell Salvage Strategies in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. J Spinal Disord Tech 2013 Nov 8.
• Bess RS, Lenke LG, Bridwell KH, Steger-May K, Hensley M. Wasting of preoperatively donated autologous blood in the surgical treatment of adolescent idiopathic scoliosis. Spine 2006;31:2375-80.
• Copley LA, Richards BS, Safavi FZ, Newton PO. Hemodilution as a method to reduce transfusion requirements in adolescent spine fusion surgery. Spine 1999;24:219-24. Joseph SA Jr, Berekashvili K, Mariller MM, Rivlin M, Sharma K, Casden A, et al. Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion. Spine 2008;33:2310-5.
• Thompson GH, Florentino-Pineda I, Poe-Kochert C. The role of amicar in decreasing perioperative blood loss in idiopathic scoliosis. Spine 2005;30(17 Suppl):S94-9.
• Kuklo TR, Owens BD, Polly DW Jr. Perioperative blood and blood product management for spinal deformity surgery. Spine J 2003;3:388-93.
• Ridgeway S, Tai C, Alton P, Barnardo P, Harrison DJ. Predonated autologous blood transfusion in scoliosis surgery. J Bone Joint Surg Br 2003;85:1032-6.
• Neilipovitz DT1, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001;93:82-7.
• Dahmani S, Orliaguet GA, Meyer PG, Blanot S, Renier D, Carli PA. Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth 2000;85:550-5.
• Ersen O, Ekıncı S, Bılgıc S, Kose O, Oguz E, Sehırlıoglu A. Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison. Musculoskelet Surg 2012;96:107-10. Nicolai P, Leggetter PP, Glithero PR, Bhimarasetty CR. Autologous transfusion in acetabuloplasty in children. J Bone Joint Surg Br 2004;86:110-2.
• Lennon RL, Hosking MP, Gray JR, Klassen RA, Popovsky MA, Warner MA. The effects of intraoperative blood salvage and induced hypotension on transfusion requirements during spinal surgical procedures. Mayo Clin Proc 1987;62:1090-4.
• Weiss JM, Skaggs D, Tanner J, Tolo V. Cell Saver: is it beneficial in scoliosis surgery? J Child Orthop 2007;1:221-7.
• Behrman MJ, Keim HA. Perioperative red blood cell salvage in spine surgery. A prospective analysis. Clin Orthop Relat Res 1992;278:51-7.
• Malcolm-Smith NA, McMaster MJ. The use of induced hypotension to control bleeding during posterior fusion for scoliosis. J Bone Joint Surg Br 1983;65:255-8.
• Bowen RE, Gardner S, Scaduto AA, Eagan M, Beckstead J. Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation. Spine 2010;35:246-51.
• Reitman CA, Watters WC 3rd, Sassard WR. The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study. Spine 2004;29:1580-4.