扩孔钻冲洗吸引器与髂嵴植骨及胫骨近端刮除术：失血和输血率有差异吗？

Reamer Irrigator Aspirator Versus Iliac Crest Bone Grafting and Proximal Tibial Curettage: Is There a Difference in Blood Loss and Transfusion Rates?

作者信息

Martella Anthony, Schumaier Adam P, Sirignano Michael N, Sagi Henry C, Wyrick John D, Archdeacon Michael T

机构信息

Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH.

出版信息

J Orthop Trauma. 2022 Apr 1;36(4):163-166. doi: 10.1097/BOT.0000000000002256.

DOI:10.1097/BOT.0000000000002256

PMID:34483318

Abstract

OBJECTIVES

To compare blood loss and transfusion rates among reamer irrigator aspirator (RIA), iliac crest bone graft (ICBG), and proximal tibial curettage (PTC) for autograft harvest.

DESIGN

Retrospective comparative study.

SETTING

Level 1 trauma center.

PATIENTS/PARTICIPANTS: The study included 139 adult patients treated between 2011 and 2018.

INTERVENTIONS

Nonunion repair of the femur or tibia using either RIA (n = 64), ICBG (n = 59), or PTC (n = 16) for autograft.

MAIN OUTCOME MEASUREMENTS

Estimated blood loss and transfusion rates.

RESULTS

Patient demographics, surgical indications, and medical comorbidities that affect bleeding did not differ among the groups. Estimated blood loss (mL) was significantly higher in the RIA group [RIA: 388 ± 368 (50-2000), ICBG: 286 ± 344 (10-2000), PTC: 196 mL ± 219 (10-700), P < 0.01]. The transfusion rate was also significantly higher in the RIA group (RIA 14%, ICBG 0%, PTC 0%, P < 0.01). The amount of graft obtained was higher in the RIA group (RIA = 48.3 mL, ICBG = 31.0 mL, PTC = 18.8 mL, P < 0.01), and the operative time (hours) was longer in the RIA group (RIA = 2.8, ICBG = 2.6, PTC = 1.9, P = 0.04).

CONCLUSION

Estimated blood loss and transfusion rates were significantly higher in patients undergoing RIA compared with those in patients undergoing ICBG and PTC; however, the incidence of transfusion after RIA (14%) was considerably lower than previous reports. These findings suggest that the risk of transfusion after RIA is present and clinically significant but lower than previously believed, and it is likely affected by the amount of graft obtained and complexity of the nonunion repair. The risk of transfusion should be discussed with patients and the choice of RIA carefully evaluated in patients who have anemia or risk factors of bleeding.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较用于自体骨采集的扩髓冲洗吸引器（RIA）、髂嵴骨移植（ICBG）和胫骨近端刮除术（PTC）的失血量和输血率。

设计

回顾性比较研究。

地点

一级创伤中心。

患者/参与者：该研究纳入了2011年至2018年期间接受治疗的139例成年患者。

干预措施

使用RIA（n = 64）、ICBG（n = 59）或PTC（n = 16）进行股骨或胫骨骨不连修复以获取自体骨。

主要观察指标

估计失血量和输血率。

结果

影响出血的患者人口统计学、手术指征和内科合并症在各组之间无差异。RIA组的估计失血量（mL）显著更高[RIA：388±368（50 - 2000），ICBG：286±344（10 - 2000），PTC：196 mL±219（10 - 700），P < 0.01]。RIA组的输血率也显著更高（RIA 14%，ICBG 0%，PTC 0%，P < 0.01）。RIA组获取的移植物量更高（RIA = 48.3 mL，ICBG = 31.0 mL，PTC = 18.8 mL，P < 0.01），且RIA组的手术时间（小时）更长（RIA = 2.8，ICBG = 2.6，PTC = 1.9，P = 0.04）。

结论

与接受ICBG和PTC的患者相比，接受RIA的患者估计失血量和输血率显著更高；然而，RIA后的输血发生率（14%）远低于先前报告。这些发现表明，RIA后存在输血风险且具有临床意义，但低于先前认为的水平，并且它可能受获取的移植物量和骨不连修复的复杂性影响。应与患者讨论输血风险，并在有贫血或出血危险因素的患者中仔细评估RIA的选择。