Peri-Operative Blood Loss and Extent of Fused Vertebrae in Surgery for Adolescent Idiopathic Scoliosis

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The goal of this study was to elucidate the features of peri-operative blood loss during the posterior surgery for adolescent idiopathic scoliosis and to examine the effectiveness of homologous blood transfusion and intra-operative cell salvage. Methods : Sixty-one adolescent idiopathic scoliosis patients who have undertaken posterior fusion surgery were recruited for the study. A homologous blood transfusion was performed in all cases. Intra-operative cell salvage was also performed in all cases. The following items were investigated : 1) pre-operative and post-operative Cobb angle ; 2) the extent of the fused vertebral body 3) ; length of the operation ; 4) intra-operative and post-operative estimated blood loss ; and 5) the need for allogenic transfusion. Results : The mean pre-operative Cobb angle was 68.2, and the post-operative Cobb angle was 21.8 degrees. The mean correction rate was 70.4 %. The extent of fused vertebrae was 5 to 15 (mean 10.3). The length of the operation was 359 ± 98 minutes. The fusion extent and length of the operation were correlated. Intra-operative blood loss was 1554 ± 1106 ml, and post-operative blood loss was 709 ± 321 ml. Allogenic transfusion was not performed in any of the cases. Peri-operative blood loss correlated with the length of the operation, extent of fused vertebrae and pre-operative Cobb angle. Conclusion : The peri-operative estimated blood loss correlated with the extent of fused vertebrae during posterior scoliosis surgery. Homologous transfusion and intra-operative cell salvage were considered to be effective for avoiding the need for allogenic transfusion.思春期特発性側弯症に対する後方矯正固定術での周術期出血量を調べ, 特に固定椎体数との関係について調査した. また, 自己血輸血および術中回収血輸血で対処可能であったか否かを調査した. （方法）思春期特発性側弯症に対して後方矯正固定術を施行した61例について, カルテ, 手術記録を調査した. 調査項目は, 側弯Cobb角（術前, 術後, 矯正率）, 固定椎体数, 手術時間, 術前自己血貯血量, 術中出血量, 術後出血量, 同種血輸血の要否について行った. （結果）術前Cobb角は68.2 ± 18.2 度, 術後Cobb角は21.8 ± 17.0 度であり, 矯正率は70.4 ±16.4％であった. 固定椎体数は5から15椎体（平均10.3 椎体）であった. 手術時間は359 ± 98分であり, 固定椎体数と手術時間の間に相関を認めた（r = 0.485, p < 0.0001）. 術中出血量は1554± 1106 ml, 術後出血量は709 ± 321 mlであった. 同種血輸血を要した症例は無かった. 周術期の出血量は手術時間（r = 0.570, p < 0.0001), 椎体固定数（r = 0.537, p < 0.0001), 術前Cobb角（r = 0.370，p = 0.0033）とそれぞれ相関を認めた. （結語）思春期特発性側弯症に対する後方矯正固定術において, 周術期出血量は手術時間, 術前Cobb角, 固定椎体数とそれぞれ相関を認めた. 同種血輸血を必要とした症例は無く, 術前自己血貯血および術中回収血輸血が有効的に利用されていると考えた.
2011-01-25

Peri-Operative Blood Loss and Extent of Fused Vertebrae in Surgery for Adolescent Idiopathic Scoliosis

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