背景:骨科手术通常需要切除骨骼或病理组织,传统方法涉及刮匙和龙骨等乐器。然而,这些方法可能是耗时的,并导致失血增加。为了减轻这些副作用,已经开发了真空辅助工具来帮助组织去除。这些设备使外科医生能够在不丢弃组织的情况下抽吸组织,可能改善骨髓炎或肿瘤切除等疾病的预后,同时能够收集材料用于下游应用。尽管研究有限,真空辅助设备显示出超越骨髓收获的希望。这项研究评估感染和清除率,估计失血量,以及与使用真空辅助组织去除相关的总手术时间,目的是了解这些设备是否可用于各种病理条件下的组织去除。
方法:从2021年12月1日至2023年7月1日,对使用Avitus®骨收获机从其原始设计重新利用进行骨科手术的患者进行了回顾性队列研究。手术分为肿瘤学,以及感染病例的清创术。感染病例进一步分为继发于创伤的病例和涉及原发感染的病例(骨髓炎和假体周围关节感染)。临床变量,包括人口统计,术中细节,并发症,和后续行动,被审查了。统计分析包括用RStudio计算的描述性统计。
结果:该研究包括44名患者,最常见的是清创感染病例(原发感染:45.5%;继发于创伤的感染:18.1%),其次是肿瘤病例(36.4%)。在所有肿瘤病例中,使用该设备建立了明确的诊断,未报告术后感染。原发感染病例的感染清除率为85.0%,创伤后感染病例的感染清除率为50.0%。在整个队列中,平均失血量为314.52mL(sd:486.74),平均总手术时间为160.93min(sd:91.07)。总的再手术率为47.7%,计划外再手术率为11.4%。
结论:真空辅助骨采集器可有效用于各种骨科手术的清创和刮除程序中。在肿瘤病例中,该装置能够有效切除组织,复发率相当,证明其在保留组织以进行准确诊断的同时最大程度地减少污染的潜力。此外,在原发感染病例的清创术中观察到骨髓炎根除率很高(85%).尽管再次手术率相对较高,为47.7%,在重新操作的各种原因的背景下解释这个数字至关重要。许多这些再操作是作为分阶段治疗方法的一部分计划的,或者与设备的性能无关。重要的是要承认,隔离设备对这些结果的贡献可能很困难。设备的使用应考虑成本效益和患者特定的风险因素。
BACKGROUND: Orthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions.
METHODS: A retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio.
RESULTS: The study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%.
CONCLUSIONS: The vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device\'s performance. It is crucial to acknowledge that isolating the device\'s contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.