Da Broi Michele, Amarossi Andrea, Spina Mauro, Meling Torstein R, Balsano Massimo
Orthopedics and Traumatology Department, University and Hospital Trust of Verona, Verona, Italy.
Regional Spinal Department, University and Hospital Trust of Verona, Verona, Italy.
Brain Spine. 2022 Mar 26;2:100883. doi: 10.1016/j.bas.2022.100883. eCollection 2022.
Early onset scoliosis (EOS) represent a challenge for spine surgeons. The selection of the best treatment is complex. Some patients, such as Jehovah's Witnesses who refuse blood transfusions, are at high risk of complication when surgical treatment is required because blood loss is a major cause of morbidity and postoperative transfusion rates.
Describe blood-saving techniques that allowed an extensive and invasive surgical procedure in a Jehovah's Witness patient.
17-year-old Jehovah's Witness girl with severe 120° Cobb Lenke 1A idiopathic scoliosis started as EOS was prepared with 4 cycles of recombinant human erythropoietin, iron and folic acid supplementation that brought her hemoglobin level from 13.6 g/dl to 16.2 g/dl. In the first surgical time, a temporary rod was implanted. Spine dissection using bipolar sealer and a special electrocautery that operates at lower temperatures than traditional ones was performed. Facetectomies and multilevel Ponte osteotomies was performed using an ultrasonic bone scalpel. The second surgical time, the definitive rods were placed, and the correction of the deformity was achieved using the rod link reducer technique.
A good correction of the main curve in the coronal plane is achieve. The Hb nadir was 7.2 g/dl four days after the second operation. The postoperative course was uneventful.
The integration of modern and traditional preoperative, intraoperative, and postoperative blood sparing techniques allowed us to perform an extensive and invasive surgical procedure in a Jehovah's Witness girl with a severe idiopathic scoliosis.
早发性脊柱侧弯（EOS）对脊柱外科医生来说是一项挑战。选择最佳治疗方案很复杂。一些患者，如拒绝输血的耶和华见证人，在需要手术治疗时并发症风险很高，因为失血是发病和术后输血率的主要原因。
描述在一名耶和华见证人患者中允许进行广泛侵入性手术的血液保存技术。
一名17岁患有严重120°Cobb Lenke 1A特发性脊柱侧弯且起病为EOS的耶和华见证人女孩，通过4个周期的重组人促红细胞生成素、铁剂和叶酸补充，使血红蛋白水平从13.6 g/dl升至16.2 g/dl。在第一次手术时，植入临时棒。使用双极密封器和一种比传统电灼器工作温度更低的特殊电灼器进行脊柱解剖。使用超声骨刀进行椎板切除术和多级 Ponte 截骨术。第二次手术时，放置确定性棒，并使用棒连接复位技术实现畸形矫正。
在冠状面实现了主曲线的良好矫正。第二次手术后四天血红蛋白最低点为7.2 g/dl。术后过程顺利。
现代和传统的术前、术中和术后血液保护技术相结合，使我们能够在一名患有严重特发性脊柱侧弯的耶和华见证人女孩身上进行广泛侵入性手术。
