Department of Orthopedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, 1 Children's Place, Suite 4S60, St. Louis, MO, 63110, USA.
Spine Deform. 2021 Mar;9(2):355-363. doi: 10.1007/s43390-020-00207-0. Epub 2020 Oct 9.
Retrospective.
Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS). Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800-1200 US) and may be of less clinical benefit in some PSF for IS.
This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10-18 years of age) who underwent primary PSF by a single pediatric spine surgeon.
Overall, 41% of cases received a mean 167 cc of ICS blood, after a mean EBL of 528 mL (range 200-1800 mL). No blood was returned in 59% of cases, with a mean EBL of 293 mL (range 75-700 mL). Only 6.5% of the entire cohort received > / = 250 cc via ICS, after a mean EBL of 773 mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p < 0.001). ICS may be more efficacious at an inflection point of 12 vertebral fusion levels, preoperative major Cobb angles > / = 55°, anesthesia exposure > / = 6 h, and with use of posterior column osteotomies (PCOs) (p < 0.05). In addition, lack of tranexamic acid use lead to greater EBL (p < 0.0001) and ICS volumes (p = 0.008).
The use of ICS in IS patients undergoing PSF resulted in the return of > / = 250 cc of ICS blood (similar volume to one allogeneic unit) in only 6.5% of cases. Charges for ICS set-up and processing of one bowl of ICS is much higher than for one allogeneic unit ($1200 vs. $462 US), hence transfusing lower volumes of autologous ICS blood is not cost-effective for all PSF for IS.
IV; Therapeutic studies.
回顾性研究。
评估在特发性脊柱侧凸（IS）的后路初次脊柱融合术（PSF）中使用 ICS 的作用和效果。术中细胞回收（ICS）可最大程度地减少失血量和异体输血的需求。但是，它会增加大量费用（800-1200 美元），并且在某些 IS 的 PSF 中可能临床获益较少。
这是一项单中心回顾性分析，纳入了 178 例连续的 IS 病例（10-18 岁），均由同一位小儿脊柱外科医生进行了初次 PSF。
总体而言，41%的病例在平均失血量为 528ml（范围 200-1800ml）后接受了平均 167cc 的 ICS 血液回收，其中 59%的病例没有血液回收，平均失血量为 293ml（范围 75-700ml）。整个队列中只有 6.5%的患者通过 ICS 回收的血量超过 250ml，平均失血量为 773ml。EBL 与融合的椎骨水平、术前主 Cobb 角和麻醉时间呈正相关（p<0.001）。ICS 在融合的椎骨水平达到 12 个、术前主 Cobb 角≥55°、麻醉暴露时间≥6 小时和使用后侧柱截骨术（PCO）时效果更明显（p<0.05）。此外，未使用氨甲环酸会导致更大的 EBL（p<0.0001）和 ICS 体积（p=0.008）。
在接受 PSF 的 IS 患者中使用 ICS，只有 6.5%的患者通过 ICS 回收的血量超过 250ml（与一个异体单位的血量相似）。ICS 的设置和处理费用一碗 ICS 比一个异体单位高得多（1200 美元比 462 美元），因此对于所有 IS 的 PSF，输注较低量的自体 ICS 血液并不具有成本效益。
IV；治疗研究。
