Department of Orthopaedic Surgery, Prisma Health Orthopaedics, Columbia, SC.
Department of Orthopaedic Surgery, Lexington Medical Center Orthopaedics, Columbia, SC.
Clin Spine Surg. 2024 Aug 1;37(7):E330-E334. doi: 10.1097/BSD.0000000000001592. Epub 2024 Feb 20.
Retrospective Cohort Study.
The purpose of this study is to assess the impact of intravenous TXA on blood loss outcomes in anterior, posterior, and combined approaches for elective cervical spine surgery.
Tranexamic acid (TXA) has been shown to reduce blood loss in a variety of operations, such as lumbar spine surgery. However, limited studies have evaluated the efficacy of TXA in cervical spine surgery.
We performed a retrospective review of a single surgeon's elective cervical spine operations between September 2011 and March 2017. Patients were divided into 3 groups: anterior approach, posterior approach, or combined approach. Patients were then further subdivided into TXA versus control groups based on whether they received TXA treatment. We performed multiple linear regressions to assess the relationship between the use of TXA and other dependent variables (number of vertebral levels treated, need for a vertebral corpectomy) on total perioperative blood loss, intraoperative estimated blood loss, postoperative drain output, total operative time, postoperative change in hemoglobin, and occurrence of transfusion and/or postoperative deep venous thrombus (DVT).
We found that the use of TXA statistically significantly reduced total perioperative blood loss ( P =0.04) and postoperative drain output ( P =0.004) in posterior surgical approach cervical spine surgery but did not statistically significantly impact any blood loss variables in anterior or combined surgical approaches to elective cervical spine surgery. The use of TXA was a significant predictor for a decrease in intraoperative ( P =0.02) and postoperative ( P <0.01) blood loss.
This study found that TXA statistically significantly decreased total blood loss and postoperative drain output when controlling for multiple confounding factors.
Level III.
回顾性队列研究。
本研究旨在评估静脉注射氨甲环酸（TXA）对择期颈椎手术前路、后路和联合入路的出血量结局的影响。
氨甲环酸（TXA）已被证明可减少多种手术（如腰椎手术）的出血量。然而，有限的研究评估了 TXA 在颈椎手术中的疗效。
我们对 2011 年 9 月至 2017 年 3 月期间一位外科医生的择期颈椎手术进行了回顾性分析。患者分为 3 组：前路、后路或联合入路。然后，根据是否接受 TXA 治疗，将患者进一步分为 TXA 组和对照组。我们进行了多元线性回归分析，以评估 TXA 的使用与其他因变量（治疗的椎体数量、是否需要椎体切除术）与总围手术期出血量、术中估计出血量、术后引流量、总手术时间、术后血红蛋白变化以及输血和/或术后深静脉血栓形成（DVT）的发生之间的关系。
我们发现，TXA 的使用在后路颈椎手术中具有统计学意义，可减少总围手术期出血量（P =0.04）和术后引流量（P =0.004），但在前路或联合颈椎手术中，对任何出血量变量均无统计学意义的影响。TXA 的使用是术中（P =0.02）和术后（P <0.01）出血量减少的显著预测因子。
本研究发现，TXA 在控制多种混杂因素后，具有统计学意义地减少了总出血量和术后引流量。
III 级。
