Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
Spine (Phila Pa 1976). 2012 Apr 20;37(9):E549-55. doi: 10.1097/BRS.0b013e31823d009b.
Therapeutic comparative study.
To evaluate the safety and efficacy of antifibrinolytic (AF) agents in reducing blood loss and transfusions during posterior spinal fusion (PSF) in children with cerebral palsy (CP) scoliosis.
Scoliosis surgery in CP children is associated with substantial blood loss. Few reports on the role of AFs exist.
A multicenter, retrospective review of a prospectively collected database of 84 consecutively enrolled patients with CF (age < 18 years) with spinal deformity who underwent PSF and instrumentation. The use of AFs, tranexamic acid (TXA), epsilon-aminocaproic acid (EACA), or none was based on the surgeon preference. Estimated blood loss (EBL), transfusion requirements, and length of stay were recorded. Analysis was performed with the independent-samples t test and 1-way analysis of variance with post hoc Bonferroni analysis.
The average age at the time of surgery was 14.4 ± 2.6 years. The groups were well matched in preoperative major deformity, age, levels fused, and operating time. Forty-four patients received AFs (30 TXA and 14 EACA), and 40 received no antifibrinolytics (NAF). The EBL averaged 1684 mL for the AFs group and 2685 mL for the NAF group (P = 0.002). There was more cell salvage transfusion in the NAF group. No significant differences were found in total transfusion requirements. There was a trend for decreased hospital stay in the AFs group. No adverse effects were seen. On comparison of the 3 groups (NAF, TXA, and EACA), a significant difference was observed between the TXA and the other groups with respect to EBL and cell salvage transfusion.
AFs significantly reduced intraoperative EBL associated with PSF, with no adverse effects; however, we could not demonstrate significant differences in total transfusion, except in cell salvage. TXA was more effective than EACA in decreasing the EBL and cell salvage transfusion.
治疗性对比研究。
评估抗纤维蛋白溶解（AF）药物在减少脑瘫（CP）脊柱侧凸儿童后路脊柱融合术（PSF）中失血量和输血的安全性和有效性。
CP 儿童的脊柱侧凸手术会导致大量失血。关于 AF 作用的报道很少。
对 84 例连续入组的 CP 脊柱畸形患者行 PSF 和器械固定术的前瞻性数据库进行多中心回顾性分析。AF 的使用，如氨甲环酸（TXA）、ε-氨基己酸（EACA）或不使用，基于外科医生的偏好。记录估计失血量（EBL）、输血需求和住院时间。采用独立样本 t 检验和单因素方差分析，并用事后 Bonferroni 分析进行组间比较。
手术时的平均年龄为 14.4 ± 2.6 岁。两组在术前主要畸形、年龄、融合节段和手术时间方面匹配良好。44 例患者接受了 AF 治疗（30 例 TXA 和 14 例 EACA），40 例患者未接受抗纤溶治疗（NAF）。AF 组的 EBL 平均为 1684ml，NAF 组为 2685ml（P = 0.002）。NAF 组的细胞回收输血更多。总输血需求无显著差异。AF 组的住院时间有缩短的趋势。未观察到不良反应。在比较 NAF、TXA 和 EACA 三组时，TXA 组与其他两组在 EBL 和细胞回收输血方面存在显著差异。
AF 显著减少 PSF 相关的术中 EBL，且无不良反应；然而，我们除了细胞回收输血之外，未能证明总输血量有显著差异。TXA 在减少 EBL 和细胞回收输血方面比 EACA 更有效。
