Department of Orthopaedics, Level 11, Derriford Hospital, Plymouth, PL6 8DH, UK.
Department of Orthopaedics, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
Int Orthop. 2019 Jul;43(7):1695-1699. doi: 10.1007/s00264-018-4104-7. Epub 2018 Aug 15.
To determine if the intraoperative use of cell salvage (CS) led to a decrease in allogeneic blood transfusion by comparing with a control group that did not receive CS. We also looked at the effects of injury severity and surgical approach.
This was a retrospective study at a major trauma center. One hundred and nineteen patients underwent open reduction and internal fixation of pelvic and acetabular fractures with (59 patients) or without intra-operative blood cell salvage (60 patients). The main outcome measurements were allogeneic blood transfusion during and after surgery with respect to CS, injury severity and surgical approach.
We did not find any significant difference in the allogeneic blood transfusion between the CS and non-CS groups (rate-62% vs. 48%, p value 0.12 {significant at < 0.05}, volume 5.56 units vs. 5.58 units, p value 0.33). The rate (71.1% vs. 48.9%, p = 0.02) and volume (7.6 units vs. 4.3 units, p value 0.00057) of post-operative blood transfusion was significantly higher in the more severely injured (ISS > 20), but there was no significant difference between the CS and non-CS groups. No significant difference was seen between either patients who had anterior or posterior surgical approaches.
We did not find CS clearly efficacious clinically or cost effective, even in the more severely injured patients or when different surgical approaches were used. We do not advocate the routine use of CS in pelvic and acetabular surgery, but selectively, based on surgeon and patient preference.
通过与未使用术中血液回收（CS）的对照组进行比较，确定术中使用 CS 是否会减少异体输血。我们还观察了损伤严重程度和手术入路的影响。
这是一家主要创伤中心的回顾性研究。119 例骨盆和髋臼骨折行切开复位内固定术，其中 59 例术中使用 CS（CS 组），60 例未使用 CS（非 CS 组）。主要观察指标为 CS、损伤严重程度和手术入路与术后异体输血的关系。
我们未发现 CS 组与非 CS 组之间异体输血有显著差异（CS 组输血率为 62%，非 CS 组为 48%，p 值 0.12{有统计学意义 <0.05}，CS 组输血体积为 5.56 单位，非 CS 组为 5.58 单位，p 值 0.33）。损伤严重程度更高（ISS>20）的患者术后输血率（71.1% vs. 48.9%，p=0.02）和输血体积（7.6 单位 vs. 4.3 单位，p 值 0.00057）明显更高，但 CS 组与非 CS 组之间无显著差异。前入路或后入路手术患者之间也未见显著差异。
即使在损伤严重程度更高的患者或使用不同手术入路时，我们也未发现 CS 具有明显的临床疗效或成本效益。我们不主张常规使用 CS 进行骨盆和髋臼手术，而是根据外科医生和患者的偏好选择性使用。
