Analysis of the effectiveness of the halo-gravitational traction system as a factor influencing blood loss in the surgical correction of complex scoliotic deformities in children

Abstract

Halo-gravity traction (HGT) systems are widely used in leading clinics around the world as a staged method for correcting complex (>100°) scoliotic deformities of the spine in children. Today there is no single approach to the use of this technique, and each doctor makes a decision regarding the treatment regimen empirically, based on his clinical experience. Purpose - to identify the factors that affect the amount of blood loss during surgical correction of scoliotic deformity in children. Materials and methods. 76 patients aged 7 to 17 years were examined, on average 11.0±2.8 years. I (experimental) group - 38 children were treated with HGT using the developed tactics of staged surgical treatment; II (control) group - 38 children who underwent one-step surgical correction. The age of children in the groups in group I was 11.0±2.8 years, in group II - 11.2±2.8 years, the age of children in groups was statistically the same (t=-0.409; p=0.684). There were 28 (36.8%) boys and 48 (63.2%) girls. The distribution of children by age and sex in the groups was the same. Data on operative blood loss were statistically processed. Results. According to the statistical study, it can be argued that the blood loss during surgical correction of scoliotic deformity is most affected by the angle of deformation and age of the patient. At an angle of deformation of >100° blood loss is significantly greater than at an angle of <100°, children over 14 years also observed a significant increase in blood loss, and this is associated not only with greater body weight but also with the fact that these children the greater the angle of deformation of the spine, as well as the use of HGT, the angle of deformation decreases less than in younger children. Conclusions. It was determined that after HGT in children the angle of deformation decreased statistically significantly (p<0.001) by an average of 36.5±14.9°. The change in deformation in boys and girls was the same. With surgical correction of scoliotic deformity <100° blood loss (1025.0±235.9 ml), (statistically significant) (p<0.001) is statistically significantly less than blood loss with correction of deformity greater than 100° (1297.5±327.8 ml). With age, blood loss increases in children, and this difference between age subgroups is statistically significant (α=0.05). The value of the angle of scoliotic deformity after surgical correction has a statistically significant (r=0.576; p=0.001) effect on blood loss, the value of surgical correction of deformity on blood loss (r=0.015; p=0.879) does not affect. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: intraoperative bleeding, spinal deformity, halo-gravity traction.