Jones Kristen E, Butler Elissa K, Barrack Tara, Ledonio Charles T, Forte Mary L, Cohn Claudia S, Polly David W
Departments of Orthopaedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN.
Department of Surgery, University of Washington, Seattle, WA.
Int J Spine Surg. 2017 Aug 4;11(4):27. doi: 10.14444/4027. eCollection 2017.
Multilevel posterior spine fusion is associated with significant intraoperative blood loss. Tranexamic acid is an antifibrinolytic agent that reduces intraoperative blood loss. The goal of this study was to compare the percent of total blood volume lost during posterior spinal fusion (PSF) with or without tranexamic acid in patients with adolescent idiopathic scoliosis (AIS).
Thirty-six AIS patients underwent PSF in 2011-2014; the last half (n=18) received intraoperative tranexamic acid. We retrieved relevant demographic, hematologic, intraoperative and outcomes information from medical records. The primary outcome was the percent of total blood volume lost, calculated from estimates of intraoperative blood loss (numerator) and estimated total blood volume per patient (denominator, via Nadler's equations). Unadjusted outcomes were compared using standard statistical tests.
Tranexamic acid and no-tranexamic acid groups were similar (all p>0.05) in mean age (16.1 vs. 15.2 years), sex (89% vs. 83% female), body mass index (22.2 vs. 20.2 kg/m2), preoperative hemoglobin (13.9 vs. 13.9 g/dl), mean spinal levels fused (10.5 vs. 9.6), osteotomies (1.6 vs. 0.9) and operative duration (6.1 hours, both). The percent of total blood volume lost (TBVL) was significantly lower in the tranexamic acid-treated vs. no-tranexamic acid group (median 8.23% vs. 14.30%, p = 0.032); percent TBVL per level fused was significantly lower with tranexamic acid than without it (1.1% vs. 1.8%, p=0.048). Estimated blood loss (milliliters) was similar across groups.
Tranexamic acid significantly reduced the percentage of total blood volume lost versus no tranexamic acid in AIS patients who underwent PSF using a standardized blood loss measure.Level of Evidence: 3. Institutional Review Board status: This medical record chart review (minimal risk) study was approved by the University of Minnesota Institutional Review Board.
多节段后路脊柱融合术与术中大量失血相关。氨甲环酸是一种抗纤溶药物，可减少术中失血。本研究的目的是比较青少年特发性脊柱侧凸（AIS）患者在接受或未接受氨甲环酸的情况下，后路脊柱融合术（PSF）期间失血量占总血容量的百分比。
2011年至2014年期间，36例AIS患者接受了PSF；后半部分（n = 18）患者术中接受了氨甲环酸治疗。我们从病历中检索了相关的人口统计学、血液学、术中及预后信息。主要结局指标是失血量占总血容量的百分比，通过术中失血量估计值（分子）和每位患者的估计总血容量（分母，通过纳德勒公式计算）得出。使用标准统计检验比较未调整的结局。
氨甲环酸组和未使用氨甲环酸组在平均年龄（16.1岁对15.2岁）、性别（女性分别为89%对83%）、体重指数（22.2kg/m²对20.2kg/m²）、术前血红蛋白（13.9g/dl对13.9g/dl）、平均融合脊柱节段数（10.5对9.6）、截骨术（1.6对0.9）和手术时长（均为6.1小时）方面相似（所有p>0.05）。与未使用氨甲环酸组相比，接受氨甲环酸治疗组的失血量占总血容量的百分比（TBVL）显著更低（中位数8.23%对14.30%，p = 0.032）；每融合一个节段的TBVL百分比，使用氨甲环酸组显著低于未使用组（1.1%对1.8%，p = 0.048）。各组间估计失血量（毫升）相似。
在接受PSF的AIS患者中，使用标准化失血测量方法，氨甲环酸与未使用氨甲环酸相比，显著降低了失血量占总血容量的百分比。证据级别：3。机构审查委员会情况：本病历图表回顾（最低风险）研究经明尼苏达大学机构审查委员会批准。
