Department of Orthopedics, Washington University, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):235-9. doi: 10.1097/BRS.0b013e3181c86cb9.
Retrospective, observational study.
To compare the safety and efficacy of 2 pharmaceutical antifibrinolytic agents, aprotinin and tranexamic acid, in controlling blood loss during lumbar pedicle subtraction osteotomy (PSO) in adults.
Reconstructive spinal surgeries, in particular lumbar PSOs, have been associated with large blood losses despite interventions (intraoperative blood salvaging, controlled hypotensive anesthesia). Since the 1990s, intraoperative administration of antifibrinolytics (aprotinin, tranexamic acid, e-aminocaproic acid) has gained popularity. This study assesses the safety and efficacy of 2 antifibrinolytics, aprotinin and tranexamic acid, during adult lumbar PSO procedures at one institution.
A retrospective comparative analysis of 44 consecutive adults undergoing posterior spinal fusion procedures with lumbar PSO at one institution was performed. Patients were analyzed according to treatment group: controls (10), aprotinin (14), and tranexamic acid (20). There were no significant differences in demographic (gender, age, comorbidities) or surgical traits (length of surgery, levels fused/exposed, preoperative hematocrit, bone graft source, primary/revision) between the 3 groups.
The aprotinin group had significantly less intraoperative blood loss (1114 +/- 992 mL; P < 0.01) than the tranexamic acid and control group (2102 +/- 1076 mL and 2260 +/- 1580 mL, respectively). The aprotinin group received significantly less blood (577 +/- 806 mL; P < 0.002) during the surgical procedure than the tranexamic acid (1838 +/- 1096 mL) and the control group (1502 +/- 1241 mL). There were no major intraoperative complications for any of the treatment groups. There were no postoperative cases of seizures, MI, CVA, DVT, or PE with any of the treatment groups. There was one acute tubular necrosis event in the aprotinin group, which resolved before discharge but did required several days of dialysis.
The aprotinin treatment group lost significantly less blood and received significantly fewer blood transfusions than both the tranexamic acid and control groups without significant differences in intra- and postoperative complications. These results may justify further study of aprotinin and other antifibrinolytics for this specific indication (3-column lumbar osteotomies in the adult spinal deformity population). A multicenter randomized comparative analysis would be ideal.
回顾性观察性研究。
比较两种药物抗纤维蛋白溶解剂，抑肽酶和氨甲环酸，在控制成人腰椎椎弓根切除截骨术（PSO）期间失血的安全性和有效性。
尽管进行了干预（术中血液回收、控制性低血压麻醉），但重建性脊柱手术，特别是腰椎 PSO，仍与大量失血相关。自 20 世纪 90 年代以来，术中给予抗纤维蛋白溶解剂（抑肽酶、氨甲环酸、e-氨基己酸）已变得流行。本研究评估了一种机构中两种抗纤维蛋白溶解剂，抑肽酶和氨甲环酸，在成人腰椎 PSO 手术中的安全性和有效性。
对一家机构中进行的 44 例连续成人后路脊柱融合术伴腰椎 PSO 的患者进行回顾性比较分析。根据治疗组分析患者：对照组（10 例）、抑肽酶组（14 例）和氨甲环酸组（20 例）。三组之间在人口统计学（性别、年龄、合并症）或手术特征（手术时间、融合/暴露的水平、术前血细胞比容、骨移植物来源、初次/翻修）方面无显著差异。
抑肽酶组术中失血量明显少于氨甲环酸组和对照组（分别为 1114 +/- 992 mL 和 2102 +/- 1076 mL 和 2260 +/- 1580 mL；P < 0.01）。抑肽酶组术中失血明显少于氨甲环酸组（577 +/- 806 mL）和对照组（1838 +/- 1096 mL）（P < 0.002）。在任何治疗组中均未发生重大术中并发症。在任何治疗组中均未发生术后癫痫发作、心肌梗死、中风、深静脉血栓形成或肺栓塞。抑肽酶组发生一例急性肾小管坏死事件，在出院前已缓解，但需要数天透析。
与氨甲环酸组和对照组相比，抑肽酶组失血量明显减少，输血量明显减少，且术中及术后并发症无显著差异。这些结果可能证明在该特定适应证（成人脊柱畸形人群中的 3 柱腰椎截骨术）中进一步研究抑肽酶和其他抗纤维蛋白溶解剂是合理的。理想情况下，这将是一项多中心随机对照分析。
