Department of Anesthesia and Intensive Care, Robert Debré Hospital, 48 boulevard Sérurier, 75019, Paris, France.
Université de Paris, Paris, France.
Eur Spine J. 2023 Mar;32(3):883-888. doi: 10.1007/s00586-022-07512-4. Epub 2023 Jan 19.
Patient blood management has been recently emphasized to avoid perioperative blood transfusion in AIS surgery. Hydroxyapatite charged collagen sponge (HCS) is a bone substitute material made of collagen and ceramized hydroxyapatite, with associated haemostatic properties. The goal of this study was to assess the impact of HCS in the perioperative blood loss in AIS surgery.
After IRB approval, all AIS patients undergoing primary correction were prospectively included over a 15-month period. Patients receiving HCS at the end of the procedure were compared to a control group (matched for age, gender, and fusion levels) without any haemostatic agent or bone substitute. The same perioperative blood saving strategies were used in both groups. Two subfascial drains were used for 48 h in all patients. Perioperative blood loss and transfusion rates were analysed.
A total of 34 patients were included in each group. No difference in drainage volume was observed at day 1, but the reduction was statistically different at day 3 (1135 mL [800-1640] versus 930 [480-1510], p = 0.028, 0.63 ml/Kg/h [0.4-0.92] versus 0.46 [0.29-0.7], p = 0.042). Multivariate analysis found that the use of HCS was associated with a decrease in the postoperative blood loss (OR = 1.17 [1.10-1.25]). The transfusion rate was lower in the HCS group [0 (0% vs. 3(8.8%), p = 0.076)]. No infection occurred, and no complication was reported.
With 27% reduction in drain volume, hydroxyapatite charged collagen sponge can be considered as a blood salving strategy in AIS surgery. The role of the biomaterial in fusion rate still needs to be further assessed.
最近强调了患者血液管理，以避免 AIS 手术中的围手术期输血。羟磷灰石胶原海绵（HCS）是一种由胶原和陶瓷化羟磷灰石组成的骨替代材料，具有止血特性。本研究的目的是评估 HCS 对 AIS 手术围手术期失血的影响。
在 IRB 批准后，在 15 个月的时间内，前瞻性地纳入所有接受初次矫正的 AIS 患者。在手术结束时使用 HCS 的患者与对照组（年龄、性别和融合水平匹配）进行比较，对照组未使用任何止血剂或骨替代物。两组均采用相同的围手术期血液保存策略。所有患者均使用 2 根皮下引流管 48 小时。分析围手术期失血和输血率。
每组共纳入 34 例患者。第 1 天引流量无差异，但第 3 天差异有统计学意义（1135ml[800-1640]与 930[480-1510]，p=0.028，0.63ml/kg/h[0.4-0.92]与 0.46[0.29-0.7]，p=0.042）。多变量分析发现，使用 HCS 与术后失血减少相关（OR=1.17[1.10-1.25]）。HCS 组输血率较低[0（0%）与 3（8.8%），p=0.076]。未发生感染，无并发症报告。
HCS 可减少 27%的引流体积，可作为 AIS 手术中的血液保存策略。生物材料在融合率中的作用仍需进一步评估。
