Nugent M, Tarrant R C, Queally J M, Sheeran P, Moore D P, Kiely P J
Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
The National Children's Research Centre, Crumlin, Dublin 12, Ireland.
Ir J Med Sci. 2016 May;185(2):513-20. doi: 10.1007/s11845-015-1306-5. Epub 2015 May 3.
Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort.
A retrospective review of 77 consecutive patients with AIS who underwent single-stage posterior spinal instrumentation and fusion over a two-year period at two Dublin tertiary hospitals was performed. Data were collected prospectively and parameters under analysis included pre- and postoperative radiographic measurements, intraoperative blood loss, surgical duration, blood products required, laboratory blood values and perioperative complications.
Mean preoperative primary curve Cobb angle was 62.3°; mean surgical duration was 5.6 h. The perioperative allogeneic red blood cell transfusion rate was 42.8 % with a median requirement of 1 unit. Larger curve magnitudes were positively correlated with longer fusion segments, increased operative time and greater estimated intraoperative blood loss. Preoperative Cobb angles greater than 70° [Relative Risk (RR) 4.42, p = 0.003] and estimated intraoperative blood loss greater than 1400 ml (RR 3.01, p = 0.037) were independent predictors of red blood cell transfusion risk.
Larger preoperative curve magnitudes in AIS increase operative time and intraoperative blood loss; preoperative Cobb angles greater than 70(o) and intraoperative blood loss greater than 1400 ml are predictive of red blood cell transfusion requirement in this patient group.
后路脊柱内固定融合术用于矫正青少年特发性脊柱侧凸（AIS）通常需要较长的手术时间，并且可能伴有大量失血及随后的输血。本研究旨在确定爱尔兰AIS队列中手术时间、术中失血量及输血需求的预测因素。
对都柏林两家三级医院在两年期间连续接受单阶段后路脊柱内固定融合术的77例AIS患者进行回顾性研究。前瞻性收集数据，分析的参数包括术前和术后影像学测量、术中失血量、手术时长、所需血液制品、实验室血液值及围手术期并发症。
术前主弯Cobb角平均为62.3°；平均手术时长为5.6小时。围手术期异体红细胞输血率为42.8%，中位数需求为1单位。更大的侧弯角度与更长的融合节段、手术时间增加及术中估计失血量增加呈正相关。术前Cobb角大于70°[相对危险度（RR）4.42，p = 0.003]及术中估计失血量大于1400 ml（RR 3.01，p = 0.037）是红细胞输血风险的独立预测因素。
AIS患者术前更大的侧弯角度会增加手术时间及术中失血量；术前Cobb角大于70°及术中失血量大于1400 ml可预测该患者群体的红细胞输血需求。
