术中椎体成形术对脊柱转移瘤分离手术术中和术后出血相关情况的影响

Impact of vertebroplasty on blood loss of separation surgery for spinal metastasis

中文关键词:  脊柱转移瘤  椎体成形术  分离手术  术中出血

英文关键词:Spinal metastasis  Vertebroplasty  Separation surgery  Intraoperative blood loss

中文摘要:

  【摘要】 目的：评估术中椎体成形术对脊柱转移瘤分离手术术中和术后出血相关情况的影响。方法：将40例单椎体胸腰椎转移瘤患者根据其手术方案的不同分为椎体成形组和对照组，每组20例。椎体成形组男12例，女8例；年龄45~68岁（56.3±7.5岁）；对照组男11例，女9例，年龄45~70岁（56.8±8.2岁）。两组患者均采用后路脊柱转移瘤分离手术，其中椎体成形组患者在置钉完成后经病椎椎弓根进行椎体成形术。两组患者年龄、性别比、原发肿瘤、转移部位、Weinstein-Boriani-Biagini（WBB）分期、Tomita分期和评分、主要症状和疼痛视觉模拟量表（visual analogue scale，VAS）评分均无统计学差异（P>0.05）。比较两组患者的手术时间、术中出血量、术中输血量、术中补液量、术后引流量及红细胞参数变化。结果：椎体成形组手术时间、术中出血量、术中补液量、术中输血量及术后引流量分别197.7±31.1min、650.0±38.7mL、3080.0±769.6mL、430.0±31.7mL、501.5±355.5mL，对照组分别为207.7±43.9min、1139.0±57.2mL、3800.5±938.7mL、810.0±48.6mL、695.5±384.9mL，两组手术时间无显著性差异（P=0.411），椎体成形组术中出血量、术中补液量、术中输血量及术后引流量均显著性低于对照组（P<0.05）。两组术前血红蛋白、红细胞数、红细胞压积均无显著性差异（P＞0.05）；术后两组均显著性降低，且椎体成形组红细胞压积明显高于对照组[（36.40±4.89）% vs （30.46±5.49）%，P=0.001）。结论：术中椎体成形术可以显著减少脊柱转移瘤分离手术出血量，减少术中补液量、输血量及术后引流量，且不增加整体手术时间。

英文摘要:

  【Abstract】 Objectives: To evaluate the impact of vertebroplasty on the blood loss during and after separation surgery for thoracolumbar metastasis. Methods: A total of 40 patients with single segment thoracolumbar metastases were divided into two groups of vertebroplasty group and control group. The vertebroplasty group(n=20) consisted of 12 males and 8 females, aged 45 to 68(average of 56.3±7.5) years old; The control group(n=20) consisted of 11 males and 9 females, aged from 45 to 70(average of 56.8±8.2) years old. All the patients underwent posterior separation surgery, except vertebroplasty group received vertebroplasty after screw placement. There was no significant difference between the two groups of patients in age, gender ratio, primary tumor, location of metastasis, Weinstein-Boriani-Biagini(WBB) classification, Tomita classification and score, main symptoms, and visual analogue scale(VAS) score(P>0.05). The operatiove time, intraoperative blood loss, intraoperative blood transfusion, intraoperative fluid transfusion, postoperative drainage volume, and erythrocyte parameters were compared between the two groups. Results: The vertebroplasty group was significantly less than the control group in intraoperative blood loss(650.0±38.73mL vs 1139.0±57.17mL), blood transfusion(430.0±31.7mL vs 810.0±48.6mL), fluid transfusion(3080.0±769.6mL vs 3800.5±938.7mL), and postoperative drainage volume(501.5±355.5mL and 695.5±384.9mL)(P<0.05). The operative time of the two groups were not significantly different(197.7±31.10min vs 207.7±43.9min, P=0.411). There was no significant difference between the two groups in preoperative hemoglobin, red blood cell count and hematocrit(HCT)(P>0.05), which were decreased significantly after surgery. And the HCT of vertebroplasty group were higher than that in the control group[(36.40±4.89)% vs (30.46±5.49)%, P=0.001]. Conclusions: Vertebroplasty in separation surgery of thoracolumbar metastasis can significantly reduce the intraoperative blood loss, fluid transfusion, and blood transfusion, as well as the postoperative drainage volume, without time extension.