腰椎後側方固定術に対するバイポーラーシーラーの有用性についての検討―前向き無作為比較

A Randomized Controlled Trial of Use of a Bipolar Sealer to Reduce Blood Loss and Operation Time during Lumbar Posterolateral Fusion

　背景：新たなディバイスであるバイポーラーシーラーが，腰椎後側方固定術(PLF)において出血量，手術時間，術後疼痛を軽減し得るかを検討した．

　対象と方法：2011年(平成23年)10月以降，PLFの適応症例を対象とし，後方展開までの時間(分)，出血量(mL)，1椎間あたりの展開時間(分)，出血量(mL)，Visual Analog Scale(VAS)，入院期間を比較検討した．

　結果：PLFで1椎間あたりの後方展開時間の短縮，出血量の減少が得られた．術後の痛みは，明らかな差はなかった．

　結語：バイポーラーシーラーはPLFの後方展開までの手術時間短縮，出血量減少に有用である．

　Background:It is still unknown whether use of a bipolar sealer reduces blood loss and tissue damage during lumbar posterolateral fusion.　The purpose of this study was to assess the efficacy of a bipolar in reducing blood loss during exposure of the lumbar spine for PLF and preventing postoperative pain.

　Methods:Thirty-five patients who were scheduled for PLF were prospectively enrolled after October 2011 and were randomly assigned to a bipolar sealer (BS) group or a standard electrocautery (control) group.　The two groups were compared with respect to operation time, blood loss during exposure of the posterior bony elements (including the transverse process) for PLF, postoperative pain on a visual analog scale (VAS), and interval between surgery and hospital discharge.

　Results:Operation time and blood loss during exposure of the bony elements were significantly lower in the BS group than in the control group.　Pain scores on the VAS 1 week postoperatively tended to be lower in the BS group.

　Discussion:We found that using a bipolar sealer is an effective means of reducing operation time and blood loss during exposure of the posterior bony elements for PLF.