目的:脊柱微创手术(MIS)可预防骨质疏松性椎体骨折(OVF)塌陷,并发症和出血率低于开放手术。然而,最近已经描述了隐性失血(HBL)的可能性,指血液的流失扩散到组织中并通过溶血而流失。本研究旨在评估HBL在接受MIS治疗OVF患者中的术后影响。
方法:这是一系列患有OVF的MIS患者的回顾性研究。对记录的变量进行了描述性分析,和总血量(VST),总出血(TB),HBL,计算Hb下降。随后进行HBL之间的比较分析(<500mL与≥500mL)以及住院时间和术后演变的变量。采用二元logistic回归模型排除混杂因素。
结果:共纳入40例患者,8男32女,平均年龄76.6岁.平均HBL为682.5mL。HBL大于500毫升被发现是一个独立的危险因素,为瑟瑟术后发展(p=0.035),虽然它不能预测更长的住院时间(p=0.116)。此外,在技术复杂性和手术时间较长的手术中观察到较高的HBL。
结论:尽管MIS技术显示术中出血少于开腹手术,应该诊断HBL,因为它与迟钝的进化有关。诊断和治疗算法的使用可以帮助最小化其影响。
OBJECTIVE: Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF.
METHODS: This was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume, total bleeding, HBL, and hemoglobine drop were calculated. This was followed by a comparative analysis between HBL (<500ml vs. ≥500ml) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors.
RESULTS: A total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5ml. An HBL greater than 500ml is found to be an independent risk factor for torpid postoperative evolution (P=0.035), while it does not predict a longer hospital stay (P=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time.
CONCLUSIONS: Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.