可吸收明胶海绵棒在椎弓根内止血的应用

目的]观察评价可吸收明胶海绵棒在椎弓根置钉过程中的止血效果。方法]2017年10月~2018年6月,48例胸腰椎骨折即将行后路手术的患者纳入本研究,采用随机数字表法分为明胶海绵组和骨蜡组。明胶海绵组共23例,置钉过程中应用明胶海绵棒填塞至椎弓根孔道止血;骨蜡组共25例,在透视定位时应用骨蜡封闭椎弓根孔道。记录置钉情况;记录术中出血量、自体血回输量、置钉过程中的出血量、输血量;检测术前和术后5 d RBC、HB和HCT。结果]两组在置钉总数、伤椎置钉数、伤椎位置各椎置钉数量的差异均无统计学意义(P>0.05)。术后两组各出现1例小腿肌间静脉血栓,抗凝治疗后于复查时消失。术后两组均无明胶海绵或骨蜡导致的不良反应。两组在术中出血量、术中自体血回收量、输血量的差异无统计学意义(P>0.05),但明胶海绵组上述指标均小于骨蜡组。每钉置入过程中明胶海绵组的出血量显著少于骨蜡组,差异有统计学意义(P<0.05)。两组术后5 d的RBC、HB和HCT均较术前显著减少,两时间点间差异均有统计学意义(P<0.05)。术前两组在RBC、HB和HCT的差异均无统计学意义(P>0.05),术后5 d两组在RBC、HB和HCT的差异亦均无统计学意义(P>0.05)。结论]应用明胶海绵棒填塞椎弓根孔道止血可显著减少安置椎弓根螺钉过程中的出血,是一种简单、安全、有效的脊柱外科术中止血方法。

Hemostasis by absorbable gelfoam stick inserted into pedicle screw tract

Objective]To evaluate the hemostatic effect of absorbable gelfoam stick inserted into the pedicle screw tract.Methods]A prospective,randomized and controlled study was conducted on 48 patients who were undergoing posterior surger?ies for thoracolumbar fractures in our hospital from October 2017 to June 2018.Of them,23 patients in the gelfoam group had the gelfoam stick inserted into the pedicle screw tract,while the remaining 25 patients in the wax group had bone wax used to seal off the track.The data of screw placement,parameters related to blood loss including intraoperative blood loss,autotransfu?sion,bleeding during screw insertion,and laboratory tests including RBC,HB and HCT were compared between the two groups.Results]There were no statistically significant differences between the two groups regarding to total screws placed,screw in?serted on the fractured vertebrae,location of the affected vertebrae and the screw placed on different levels(P>0.05).Intermus?cular venous thrombosis happened in 2 patients,one in each group,which subsided after anticoagulation therapy.No adverse re?action related to gelfoam and bone wax occurred in anyone of them postoperatively.The gelfoam group had less intraoperative blood loss,autotransfusion and transfusion than the wax group,despite of no statistically significant differences between the two groups(P>0.05).However,the gelfoam group had significantly less blood loss during screw insertion on average(P<0.05).Re?garding to laboratory tests,the RBC,HB and HCT significantly decreased at 5 days postoperatively compared with those before operation in both groups(P<0.05),nevertheless no statistically significant differences in aforesaid parameters were proved be?tween the two group before operation and at 5 days after operation(P>0.05).Conclusion]This gelfoam stick inserted into tract during pedicle screw placement does significantly reduce blood loss,and is a simple,safe and effective method for hemostasis.