尽管明胶-凝血酶基质封闭剂已成功用于其他手术类型,它们对单级经椎间孔腰椎椎间融合术中减少失血的作用尚不清楚.因此,我们检查了明胶-凝血酶基质密封剂在此类手术中减少失血的功效。我们分析了102例接受单级经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的患者。我们比较了体重指数,手术时间,术中失血,术后失血,真实的总失血量,隐藏的失血,输血的比例,手术前后的血压(收缩压和舒张压),以及手术前后的实验室数据(血红蛋白,血细胞比容,血小板,凝血酶原时间,活化部分凝血活酶时间,和D-二聚体)在手术过程中使用明胶-凝血酶基质密封剂(GTMS组)或未使用(对照组)的患者之间。使用磁共振成像测量术后一周的硬膜外血肿大小。GTMS组和对照组包括54名患者(24名男性和30名女性)和48名患者(19名男性和29名女性)。术中,真实总计,GTMS组的隐性失血;硬膜外血肿大小;住院时间明显低于对照组。术中出血量与手术时间相关(R=0.523,P=.001),体重指数(R=0.221,P=0.036),和使用的明胶-凝血酶基质密封剂的量(r=-0.313,P=.002)。在以术中失血量为因变量的多元线性回归分析中,手术时间(标准化系数0.516,P=.001)和明胶-凝血酶基质密封剂用量(标准化系数-0.220,P=.032)是独立相关因素.在我们的研究中,GTMS组术中真实总失血量和隐性失血量明显少于对照组.因此,在经椎间孔腰椎椎间融合术中,使用明胶-凝血酶基质封闭剂可减少围手术期失血量.
Although gelatin-thrombin matrix sealants have been used successfully in other surgery types, their effect on reducing blood loss during single-level transforaminal lumbar interbody fusion is unclear. We thus examined the efficacy of gelatin-thrombin matrix sealants for reducing blood loss during such surgery. We analyzed 102 patients who underwent single-level transforaminal lumbar interbody fusion for lumbar degenerative disease. We compared body mass index, surgical time, intraoperative blood loss, postoperative blood loss, true total blood loss, hidden blood loss, the proportion of blood transfusion, blood pressure pre- and post-surgery (systolic and diastolic), and pre-and post-surgery laboratory data (hemoglobin, hematocrit, platelets, prothrombin time, activated partial thromboplastin time, and D-dimer) between patients in whom gelatin-thrombin matrix sealants were (GTMS group) or were not (control group) used during surgery. One-week postoperative epidural hematoma size was measured using magnetic resonance imaging. The GTMS and control groups included 54 (24 males and 30 females) and 48 patients (19 males and 29 females). Intraoperative, true total, and hidden blood loss; epidural hematoma size; and hospitalization duration were significantly lower in the GTMS than in the control group. Intraoperative blood loss correlated with surgical time (R = 0.523, P = .001), body mass index (R = 0.221, P = .036), and the amount of gelatin-thrombin matrix sealant used (r = -0.313, P = .002). In multivariate linear regression analysis using intraoperative blood loss as the dependent variable, surgical time (standardization coefficient 0.516, P = .001) and amount of gelatin-thrombin matrix sealant used (standardization coefficient -0.220, P = .032) were independently related factors. In our study, the GTMS group had significantly less intraoperative true total and hidden blood loss than did the control group. Thus, use of gelatin-thrombin matrix sealants reduce perioperative blood loss in transforaminal lumbar interbody fusion.