Cakir Balkan, Ulmar Benjamin, Schmidt René, Kelsch Georg, Geiger Peter, Mehrkens Hans-Hinrich, Puhl Wolfhart, Richter Marcus
Department of Orthopaedics and Spinal Cord Injury, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Eur Spine J. 2006 Jan;15(1):48-54. doi: 10.1007/s00586-004-0812-3. Epub 2005 Feb 15.
Different methods to reduce blood loss during spinal surgery have been described already. Although the use of the harmonic scalpel (HS), an ultrasonically activated coagulator, has been described in endoscopic spinal surgery, its efficacy in posterior instrumentation of the spine remains unclear. The aim of this study was to determine if blood loss was lower using the HS than electrocauterization (EC) and to evaluate the cost effectiveness of the HS in reducing the need for transfusion in patients undergoing posterior instrumentation of the spine. The two groups were matched in a blinded manner, without knowledge of blood loss and were similar with respect to mean age, diagnosis and operation data. All instrumentations were done by the same surgeon. After matching was completed (HS group n = 50, EC group n = 50) blood loss and overall costs for blood products were analyzed by independent observers. The following were significantly lower with the HS than with EC: (1) blood loss (1106+/-985 ml vs 2176+/-1764 ml, P < 0.001), (2) frequency of cell saver use (13 vs 28 patients, P = 0.001), (3) average cost of blood products (Euro 72 vs Euro 219, P < 0.001), (4) predonation of autologous fresh frozen plasma (2.58+/-2.78 vs 4.5+/-2.2 U, P = 0.002) and red blood cells (0.38+/-0.75 vs 0.88+/-1.1 U, P = 0.009). The overall costs, including the costs for the HS, remained neutral. The use of the HS in posterior spinal surgery leads to significantly lower blood loss, and less need for and cost of blood products, compared to EC in cases with major anticipated blood loss.
已有文献描述了脊柱手术中减少失血的不同方法。尽管谐波手术刀（HS），一种超声激活的凝血器，已在内镜脊柱手术中有所描述，但其在脊柱后路内固定手术中的疗效仍不明确。本研究的目的是确定使用HS时的失血量是否低于电灼术（EC），并评估HS在减少脊柱后路内固定手术患者输血需求方面的成本效益。两组采用盲法匹配，不了解失血量情况，且在平均年龄、诊断和手术数据方面相似。所有内固定手术均由同一位外科医生完成。匹配完成后（HS组n = 50，EC组n = 50），由独立观察者分析失血量和血液制品的总体成本。与EC相比，HS组以下各项显著更低：（1）失血量（1106±985 ml对2176±1764 ml，P < 0.001），（2）细胞回收器的使用频率（13例对28例患者，P = 0.001），（3）血液制品的平均成本（72欧元对219欧元，P < 0.001），（4）自体新鲜冰冻血浆的预存（2.58±2.78对4.5±2.2 U，P = 0.002）和红细胞（0.38±0.75对0.88±1.1 U，P = 0.009）。包括HS成本在内的总体成本保持平衡。与EC相比，在预计失血量大的情况下，脊柱后路手术中使用HS可显著减少失血量，降低血液制品的需求和成本。
