Derman Peter B, Kamath Atul F, Lee Gwo-Chin
Resident, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Am J Orthop (Belle Mead NJ). 2013 Sep;42(9):407-11.
Blood conservation with saline-coupled bipolar sealing devices in primary total knee arthroplasty (TKA) has had mixed results. Moreover, investigators have not studied these devices in infected TKA cases in which conventional methods of blood management cannot be used. We conducted a single-surgeon, case-control study to evaluate how the choice of an electrocautery device affects total blood loss, transfusion requirements, and total cost in revision TKA for infection. Each of the 80 patients in the study had an infected TKA and underwent surgery that involved the use of a saline-coupled bipolar sealing device at our institution. Results were compared with those of a control group of 40 patients immediately predating use of this device. Groups were matched for age, body mass index, American Society of Anesthesiologists (ASA) classification, and surgery type. We then compared the groups on multiple variables, including total blood loss, transfusion requirements, operative time, and hemoglobin decrease. The groups did not differ with respect to blood loss or transfusion requirements. However, operative time was significantly lower in the bipolar sealer group. This difference translated to an average net additional cost of about $70 per case. Given the results of this study, use of a saline-coupled bipolar sealing device in patients with infected TKAs is not clinically or economically justified.
在初次全膝关节置换术（TKA）中，使用盐水耦合双极密封装置进行血液保护的效果不一。此外，研究人员尚未在无法使用传统血液管理方法的感染性TKA病例中研究这些装置。我们进行了一项单医生病例对照研究，以评估电灼装置的选择如何影响感染性翻修TKA中的总失血量、输血需求和总成本。该研究中的80名患者均患有感染性TKA，并在我们机构接受了使用盐水耦合双极密封装置的手术。将结果与紧接在使用该装置之前的40名患者的对照组进行比较。两组在年龄、体重指数、美国麻醉医师协会（ASA）分级和手术类型方面进行匹配。然后，我们在多个变量上比较两组，包括总失血量、输血需求、手术时间和血红蛋白下降情况。两组在失血量或输血需求方面没有差异。然而，双极密封器组的手术时间明显更短。这种差异转化为每例病例平均约70美元的额外净成本。鉴于这项研究的结果，在感染性TKA患者中使用盐水耦合双极密封装置在临床或经济上都不合理。
