Cem ÇOPUROĞLU, Selçuk ERCAN, MERT ÖZCAN, MERT ÇİFTDEMİR, F. Nesrin TURAN, Erol YALNIZ

Omurga cerrahisinde otojen kemik greftlerinin alındıkları bölgeye uygulanan hemostatik ajanların karşılaştırılması

Amaç: Çalışmamızda, omurga füzyonunda kullanılan otogreftlerin, alındıkları bölgeye uygulanan hemostatik ajanların etkilerinin incelenmesi amaçlandı. Çalışma planı: Çalışmaya Mart 1999 ve Ekim 2002 tarihleri arasında spinal füzyon cerrahisi geçiren 66 hasta (26 erkek, 40 kadın; ortalama yaş: 42.9) kabul edildi. Hastalar hemostatik ajan seçimine göre rastgele 4 farklı gruba ayrıldı. Çalışma grupları; kemik mumu uygulanan hastalar (Grup 1), spongostan uygulanan hastalar (Grup 2), spongostan uygulanıp 10 dakika sonra alınan hastalar (Grup 3) ve hemostatik ajan uygulanmayan kontrol grubu (Grup 4) şeklinde oluşturuldu. Grupların seçiminde, hastaların yaşı, cinsiyeti, tanısı ve insizyonun şekli dikkate alınmadı. Hastaların drenaj miktarları kapalı emici drenaj sistemleri ile değerlendirildi. Drenaj miktarı günlük 30 cc’nin altına düşen hastalarda drenaj sistemleri 48 saat takip edilip sonlandırıldı. Bulgular: Grup 1’de hematom miktarında oldukça anlamlı bir azalma tespit edildi. Grup 2 ve 3’te gözlenen hematom miktarı kontrol gubundakinden az idi. Greft alımı için ayrı bir insizyon söz konusu olduğunda, spongostanın sahada bırakılmasının (Grup 2) uygulanıp alınmasından (Grup 3) daha etkin olduğu görüldü. Çıkarımlar: Kanayan süngerimsi kemik yüzeylerine, kemik mumu ve spongostan uygulanması kanama miktarını azaltır. Hemostaz açısından kemik mumu, spongostana göre daha etkindir.

Comparison of autogenous bone graft donor site haemostatic agents used in spinal surgery

Objective: The aim of our study was to investigate the effects of haemostatic agents used at the autograft donor sites in spinal fusion. Methods: The study included 66 patients (26 men, 40 women; mean age: 42.9 years) who underwent spinal fusion surgery between March 1999 and October 2002. Patients were randomly assigned to 4 different groups according to the haemostatic agents used during surgery. In Group 1, bone wax was used on the graft donor site. In Group 2, spongostan was used. In Group 3, spongostan was applied to the donor site and removed after 10 minutes. Group 4 was the control group and no haemostatic agent was applied. Age, sex, diagnosis and incision shape were not taken into consideration during the selection of patient groups. Closed suction drainage systems were used for the evaluation of drainage amount. The drainage system was removed after 48 hours in patients with a daily drainage of less than 30 cc. Results: In Group 1, there was significantly less drainage than the other groups. Group 2 and Group 3 had less drainage than the control group. When a separate incision was used for graft harvesting, keeping the spongostan at the application site (Group 2) was more effective than its removal (Group 3). Conclusion: The application of bone wax and spongostan to bleeding cancellous bone surfaces at the donor site is a safe and effective method to reduce bleeding and hematoma. Bone wax is more effective than spongostan for haemostasis.

___

1. Bilgin A, Ermifl ‹, Ayd›n ‹, Topalan M, Olgaç V. Otojen enkondral kemik greftlerinin yumuflak dokulardaki ak›beti. Acta Orthop Traumatol Turc 1999;33:201-4.
2. Cuckler JM, Iannotti JP, Brighton CT. Reconstructive surgery of the adult hip: Grafting procedures. In: Steinberg ME, editor. The hip and its disorders. Philadelphia: WB Saunders; 1991 p. 856-60.
3. Cobb JP. Why Use Drains? J Bone Joint Surg Br 1990;72: 993-5.
4. Nigel RC, Drew AB. Procurement of bone graft from the iliac crest. J Bone Joint Surg Br 1997;79:756-9.
5. Sasso RC, Williams JI, Dimasi N, Meyer PR. Postoperative drains, at the donor sites of iliac-crest bone grafts. J Bone Joint Surg Am 1998;80:631-5.
6. Domaniç Ü. Posterior füzyon ve kemik greftleri. In: Ege R. Vertebra - Omurga. Ankara: Türk Hava Kurumu Bas›mevi; 1992. p. 257-94.
7. Zirna H, Keating SE, DeVicentis AF. Topical hemostatic agents to reduce bleeding from cancellous bone surfaces. A comparison of Gelfoam paste and bone wax. J Foot Surg 1987;26:496-500.
8. Tiggers R. The ideal haemostatic agent. Curaspon Healtcare Yweg 911161 Et. http//www.curamedical.com.
9. Andrew H, Crenshaw JR. Surgical techniques and approaches. Bone grafting. Campbell’s operative orthopaedics. In: Canale ST, editor. 9th ed. Vol. 1. St. Luois: Mosby; 1998. p. 40-7.
10. Chandratreya KG, Livesley P. To drain or not drain: literature versus practice. J R Coll Surg 1998;43:404-6.
11. Wang JC, Bohlman HH, Rief KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year minimum follow-up of eightyeight patients. J Bone Joint Surg Am 1998;80:1728-34.
12. Willett KM, Simmons CD, Bentley G. The effect of suction drains after total hip replacement. J Bone Joint Surg Br 1998;70:607-10.
13. Beer KJ, Lombardi AV, Mallory TH, Vaughn BK, The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am 1991;73:584-6.
14. Taheri Z. The use of gelfoam paste in anterior cervical fusion. J Neurosurg 1971;34:438.
15. Wang MY, Armstrong JK, Fisher TC, Meiselman HJ, McComb GJ, Levy ML. A new, pluronic-based, bone hemostatic agent that does not impair osteogenesis. Neurosurgery 2001;49:962-7.
16. Civelek A, Ye¤en C, Aktan Ö. The use of bone wax to control massive presacral bleeding. Surg Today 2002;32: 944-5.
17. Bohy B, Feyen J, Smits P, Nuyts R. Bone wax as a way to prevent hematoma after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2002;18:E45.
18. Prziborowski J, Hartrumpf M, Stock UA, Kuehnel RU, Albes JM. Is bone wax safe and does it help? Ann Thorac Surg 2008;85:1002-6.
19. Schonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J 2004;13(Suppl. 1):S89-S96.
20. Wilkinson HA, Baker S, Rosenfeld S. Gelfoam paste in experimental laminectomy and cranial trephination: hemostasis and bone healing. J Neurosurg 1981;54:664-7. 364 Acta Orthop Traumatol Turc