Nugraha Hans K, Sample Jack W, Curran Brett F, Potter D Dean, Milbrandt Todd A, Larson A Noelle
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Spine Deform. 2025 Apr 8. doi: 10.1007/s43390-025-01089-w.
Vertebral body tethering (VBT) is an emerging treatment option for idiopathic scoliosis, but routinely requires intraoperative placement of a chest tube (CT). Topical thrombin and injectable collagen have routinely been used as a hemostatic agent, but data are lacking on its use in VBT. Thus, we aim to investigate the impact of the topical hemostatic use on CT output and duration, and the subsequent rate of clinically-significant hemothorax and effusion after VBT.
Retrospective review was conducted on patients who underwent VBT at a single institution between 2015 and 2024. Patients were grouped to whether they were treated with FDA-approved, topically applied recombinant thrombin and injectable collagen intraoperatively. We hypothesized that there would be fewer thoracic and chest tube complications in the topical hemostatic group based on their 90-day perioperative outcomes.
Out of 190 patients who underwent VBT, 92 received thrombin and injectable collagen intraoperatively while 98 did not. Mean age at surgery was 13 (range 9-17) years. Adjusting for chest tube size and number of instrumented levels, regression analysis showed significant decrease in CT output, CT duration, and the odds of developing clinically significant pleural effusion with the use of intraoperative topical hemostatic agents. Two cases of in-hospital hemothorax were found in the non-topical hemostatic group and none in the group with topical hemostatic.
Applying topical thrombin and injectable collagen during surgery decreases CT output and duration following VBT, as well as the odds of developing clinically significant pleural effusion. This may serve as an alternative to the use of 24-h intravenous hemostatic agent such as tranexamic acid.
Level III-Retrospective Cohort Study.
Level III-Retrospective Cohort Study.
椎体牵张术（VBT）是一种治疗特发性脊柱侧凸的新兴方法，但通常需要在术中放置胸管（CT）。局部凝血酶和可注射胶原蛋白一直被用作止血剂，但在VBT中的应用数据尚缺。因此，我们旨在研究局部止血剂的使用对胸管引流量和留置时间的影响，以及VBT术后发生具有临床意义的血胸和气胸的后续发生率。
对2015年至2024年在单一机构接受VBT的患者进行回顾性分析。根据患者术中是否使用美国食品药品监督管理局（FDA）批准的局部应用重组凝血酶和可注射胶原蛋白进行分组。我们假设，基于围手术期90天的结果，局部止血组的胸腔和胸管并发症会更少。
在190例行VBT的患者中，92例术中接受了凝血酶和可注射胶原蛋白，98例未接受。手术时的平均年龄为13岁（范围9 - 17岁）。在调整胸管尺寸和固定节段数量后，回归分析显示，使用术中局部止血剂可显著减少胸管引流量、缩短胸管留置时间，并降低发生具有临床意义的胸腔积液的几率。非局部止血组发现2例院内血胸，局部止血组未发现。
手术中应用局部凝血酶和可注射胶原蛋白可减少VBT术后的胸管引流量和留置时间，以及发生具有临床意义的胸腔积液的几率。这可能是使用氨甲环酸等24小时静脉止血剂的替代方法。
III级——回顾性队列研究。
III级——回顾性队列研究。
