Abstract
Amaç
Adelösan idiopatik skolyozun cerrahi tedavisinde kan kaybı miktarı ve cerrahi süreler önemli parametrelerdendir(1). Literatürde ultrasonik kemik kesicilerin kanama miktarını azalttığını bildiren çalışmlar olduğu gibi; kan kaybı bakımından etkisiz olduğunu bildiren çalışmalar damevcuttur(8,11). Çalışmamızın amacı ultrasonik kemik kesici kullanılarak cerrahi tedavi uygulanan hastalar ile klasik el osteotomlarıyla osteotomi uygulanan hastaları, cerrahi süre ve kan kaybı miktarı bakımından karşılaştırarak literatüre katkı sağlamaktır.
Gereç ve Yöntemler
Çalışmaya skolyoz ve kifoz tanısı alarak cerrahi olarak tedavi edilen 26 hasta dahil edildi. Hastalar osteotomi sırasında ultrasonik kemik kesici uç kullanılıp kullanılmamasına göre iki gruba ayrıldı. Hastaların yaş, cinsiyet, deformite tipi, osteotomi uygulanan segment sayısı, füzyon uygulanan segment sayısı, cerrahi süre, cerrahi sırasındaki tahmini kan kaybı miktarları, cerrahi sonrası kan transfüzyonu miktarı, hastanede kalış süresi ve komplikasyonlarla ilgili verileri retrospektif olarak taranarak kaydedildi. Gruplar arasında anlamlı istatistiksel farklılıklar araştırıldı
Bulgular
26 hasta’nın %65,4’ü (n= 17) kadın, %34,6’sı (n=9) erkektir. Hastaların %69,2’si (n=18) skolyoz ve % 30,8’i (n=8) kifoz hastasıdır. İki grupta bulunan hastalar füzyon seviyesi, osteotomi seviyeleri, ameliyat süresi, kanama miktarları açısından karşılaştırıldığında anlamlı fark yoktur. İki grup kanama miktarı /füzyon seviyeleri oranlarının açısından karşılaştırıldığında anlamlı fark yoktur. (p=0,781).
Sonuç
Ultrasonik kemik kesicilerin osteotomi sırasında kullanımının cerrah açısından klasik osteotomlara göre kolaylık sağladığı ve komplikasyonları azalttığı düşünülmektedir. Mevcut literatürde farklı sonuçlar bildirilmiştir. Çalışmamıza göre ultrasonik kesicilerin klasik osteotomlara göre anlamlı bir etkisi bulunmamıştır. Ultrasonik kemik kesicilerin omurga cerrahisinde kullanımı ile ilgili daha geniş vaka serileri ile yapılacak randomize kontrollü çalışmalar gerekmektedir.
Keywords
References
- 1. Thompson ME, Kohring JM, McFann K, McNair B, Hansen JK, Miller NH. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J. 2014 Aug 1;14(8):1392-8. doi: 10.1016/j.spinee.2013.08.022. Epub 2013 Oct 18. PMID: 24139751.
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- 3. Modi HN, Suh SW, Hong JY, Song SH, Yang JH. Intraoperative blood loss during different stages of scoliosis surgery: A prospective study. Scoliosis. 2010 Aug 7;5:16. doi: 10.1186/1748-7161-5-16. PMID: 20691105; PMCID: PMC2924263.
- 4. Sherman JA, Davies HT. Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery. Br J Oral Maxillofac Surg. 2000 Oct;38(5):530-2. doi: 10.1054/bjom.2000.0502. PMID: 11010788.
- 5. Horton JE, Tarpley TM Jr, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol. 1981 Mar;51(3):236-42. doi: 10.1016/0030-4220(81)90051-7. PMID: 6938883.
- 6. Parker SL, Kretzer RM, Recinos PF, Molina CA, Wolinsky JP, Jallo GI, Recinos VR. Ultrasonic BoneScalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note. Neurosurgery. 2013 Sep;73(1 Suppl Operative):ons61-6. doi: 10.1227/NEU.0b013e318283c98b. PMID: 23262563.
- 7. Gilles R, Couvreur T, Dammous S. Ultrasonic orthognathic surgery: enhancements to established osteotomies. Int J Oral Maxillofac Surg. 2013 Aug;42(8):981-7. doi: 10.1016/j.ijom.2012.12.004. Epub 2013 Jan 8. PMID: 23312501.
- 8. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J. 2013 Dec;22(12):2845-9. doi: 10.1007/s00586-013-2780-y. Epub 2013 Apr 16. PMID: 23584231; PMCID: PMC3843782.
- 9. Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011 Nov;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. Epub 2011 Sep 13. PMID: 21917459.
- 10. Pakzaban P. Bone Scalpel Ultrasonic Bone Dissector: applications in spine surgery and surgical technique guide. Farmingdale, NY: Misonix,Inc.; 2013.
- 11. Garg S, Thomas J, Darland H, Kim E, Kittelson J, Erickson M, Carry P. Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS): Randomized Clinical Trial. Spine (Phila Pa 1976). 2021 Jul 1;46(13):845-851. doi: 10.1097/BRS.0000000000003990. PMID: 34100838.
- 12. Bartley CE, Bastrom TP, Newton PO. Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel. Spine Deform. 2014;2(4):285-290. doi:10.1016/j.jspd.2014.03.008
- 13. Wahlquist S, Nelson S, Glivar P. Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery. Spine Deform. 2019;7(4):582-587. doi:10.1016/j.jspd.2018.10.002
Abstract
Objective: The aim of our study is to contribute to the literature by comparing the patients who underwent surgical treatment using ultrasonic bone cutter and the patients who underwent osteotomy with hand osteotomes in terms of surgical time and amount of blood loss.
Materials and methods: Patients who underwent scoliosis and kyphosis surgery were evaluated. Patients were divided into two groups according to whether or not ultrasonic bone scalpel was used during osteotomy. The patients' age, gender, type of deformity, number of osteotomy segments, number of fusion segments, surgical time, estimated blood loss, amount of blood transfusion after surgery, duration of staying hospital and complications were recorded retrospectively. Significant statistical differences between groups were investigated.
Results: 26 patients were included in the study. 65.4% (n= 17) were female and 34.6% (n=9) were male. 69.2% (n=18) had scoliosis and 30.8% (n=8) had kyphosis. There was no significant difference between the two groups in terms of fusion level, osteotomy levels, operation time, and amount of bleeding. There was no significant difference between the amount of bleeding / fusion levels in the two groups. (p=0.781).
Conclusion: It is thought that the use of ultrasonic bone scalpel during osteotomy provides convenience for the surgeon and reduces complications compared to classical osteotomes. Different results have been reported in the literature. In our study, no significant effect of ultrasonic bone scalpel was found compared to osteotomes. Randomized controlled studies with larger case series on the use of ultrasonic bone scalpel in spine surgery are required.
Keywords
References
- 1. Thompson ME, Kohring JM, McFann K, McNair B, Hansen JK, Miller NH. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J. 2014 Aug 1;14(8):1392-8. doi: 10.1016/j.spinee.2013.08.022. Epub 2013 Oct 18. PMID: 24139751.
- 2. Shapiro F, Sethna N. Blood loss in pediatric spine surgery. Eur Spine J. 2004 Oct;13 Suppl 1(Suppl 1):S6-17. doi: 10.1007/s00586-004-0760-y. Epub 2004 Aug 13. PMID: 15316883; PMCID: PMC3592180.
- 3. Modi HN, Suh SW, Hong JY, Song SH, Yang JH. Intraoperative blood loss during different stages of scoliosis surgery: A prospective study. Scoliosis. 2010 Aug 7;5:16. doi: 10.1186/1748-7161-5-16. PMID: 20691105; PMCID: PMC2924263.
- 4. Sherman JA, Davies HT. Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery. Br J Oral Maxillofac Surg. 2000 Oct;38(5):530-2. doi: 10.1054/bjom.2000.0502. PMID: 11010788.
- 5. Horton JE, Tarpley TM Jr, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol. 1981 Mar;51(3):236-42. doi: 10.1016/0030-4220(81)90051-7. PMID: 6938883.
- 6. Parker SL, Kretzer RM, Recinos PF, Molina CA, Wolinsky JP, Jallo GI, Recinos VR. Ultrasonic BoneScalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note. Neurosurgery. 2013 Sep;73(1 Suppl Operative):ons61-6. doi: 10.1227/NEU.0b013e318283c98b. PMID: 23262563.
- 7. Gilles R, Couvreur T, Dammous S. Ultrasonic orthognathic surgery: enhancements to established osteotomies. Int J Oral Maxillofac Surg. 2013 Aug;42(8):981-7. doi: 10.1016/j.ijom.2012.12.004. Epub 2013 Jan 8. PMID: 23312501.
- 8. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J. 2013 Dec;22(12):2845-9. doi: 10.1007/s00586-013-2780-y. Epub 2013 Apr 16. PMID: 23584231; PMCID: PMC3843782.
- 9. Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011 Nov;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. Epub 2011 Sep 13. PMID: 21917459.
- 10. Pakzaban P. Bone Scalpel Ultrasonic Bone Dissector: applications in spine surgery and surgical technique guide. Farmingdale, NY: Misonix,Inc.; 2013.
- 11. Garg S, Thomas J, Darland H, Kim E, Kittelson J, Erickson M, Carry P. Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS): Randomized Clinical Trial. Spine (Phila Pa 1976). 2021 Jul 1;46(13):845-851. doi: 10.1097/BRS.0000000000003990. PMID: 34100838.
- 12. Bartley CE, Bastrom TP, Newton PO. Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel. Spine Deform. 2014;2(4):285-290. doi:10.1016/j.jspd.2014.03.008
- 13. Wahlquist S, Nelson S, Glivar P. Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery. Spine Deform. 2019;7(4):582-587. doi:10.1016/j.jspd.2018.10.002
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 27, 2021 |
| Submission Date | November 17, 2021 |
| Published in Issue | Year 2021 Volume: 11 Issue: 4 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.