Sasagawa Takeshi, Takeuchi Yosuke, Aita Ikuo
Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan.
Department of Orthopedic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Spine Surg Relat Res. 2020 Oct 22;5(3):171-175. doi: 10.22603/ssrr.2020-0152. eCollection 2021.
Some reports revealed that hidden blood loss (HBL) during surgery for traumatic thoracolumbar fracture cannot be ignored, even when using a percutaneous approach. Using percutaneous pedicle screws (PPS) for traumatic thoracolumbar fracture, this study aimed to compare estimate blood loss (EBL), including HBL, between early and late fixation.
This investigation was a retrospective study. In the present study, data from 39 patients who underwent posterior spinal stabilization using PPS for single-level thoracolumbar fracture have been included. We divided the patients into an early group (group E) (n=20) in whom surgery was conducted within 3 days of fracture and a late group (group L) (n=19) in whom surgery was conducted more than 3 days after fracture. We evaluated hemoglobin (Hb) on the day of injury, and 1, 3 or 4, and 7 days after surgery, EBL, HBL, and transfusion requirement.
Hb on day 1 (group E: 12.2±1.7 g/dL, group L: 12.3±1.6 g/dL) was significantly less than that on the injured day (group E: 14.2±1.7 g/dL, group L: 13.9±1.7 g/dL) in both groups. The values of Hb and EBL were not significantly different at any time between the two groups. HBL (group E: 487±266 mL, group L: 386±305 mL) was not significantly different between the two groups. No patients required transfusion in either group.
EBL in early fixation using PPS for traumatic thoracolumbar fracture is not significantly different compared with that in late surgery from days 1 to 7 postoperatively. Early fixation using PPS for traumatic thoracolumbar fracture does not result in negative outcomes any more than those in late surgery in terms of blood loss.
一些报告显示，外伤性胸腰椎骨折手术期间的隐性失血（HBL）不容忽视，即便采用经皮入路亦是如此。本研究采用经皮椎弓根螺钉（PPS）治疗外伤性胸腰椎骨折，旨在比较早期和晚期固定时的估计失血量（EBL），包括隐性失血。
本研究为回顾性研究。纳入39例行PPS后路脊柱固定治疗单节段胸腰椎骨折患者的数据。将患者分为早期组（E组）（n = 20），于骨折后3天内进行手术；晚期组（L组）（n = 19），于骨折后3天以上进行手术。评估受伤当天、术后1、3或4及7天的血红蛋白（Hb）、EBL、HBL及输血需求。
两组术后第1天的Hb（E组：12.2±1.7 g/dL，L组：12.3±1.6 g/dL）均显著低于受伤当天（E组：14.2±1.7 g/dL，L组：13.9±1.7 g/dL）。两组间任何时间的Hb和EBL值均无显著差异。两组间HBL（E组：487±266 mL，L组：386±305 mL）无显著差异。两组均无患者需要输血。
外伤性胸腰椎骨折采用PPS早期固定与术后1至7天的晚期手术相比，EBL无显著差异。外伤性胸腰椎骨折采用PPS早期固定在失血方面不会比晚期手术产生更负面的结果。
