Dynamic Positioning of Scoliotic Patients During Spine Instrumentation Surgery
Dynamic Positioning of Scoliotic Patients During Spine Instrumentation Surgery
复制标题
脊柱内固定手术中脊柱侧凸患者的动态定位
DOI：
10.1097/bsd.0b013e3181753afd
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发表时间：
2009
影响因子：
--
通讯作者：
H. Labelle
中科院分区：
文献类型：
--
作者：
K. Duke;C. Aubin;J. Dansereau;A. Koller;H. Labelle
研究设计评价脊柱侧凸手术中用于改善术前矫正的新型动力定位架（DPF）。目的评估脊柱侧凸手术中的DPF，并证明其设计如何提供额外的三维畸形术前矫正。背景资料概要患者体位是脊柱侧凸手术中的重要步骤。虽然目前的定位框架的重点是支持病人和保持腹部下垂，以减少失血，没有太多的已经进行了探索方面的动态定位在手术期间。当俯卧时，由于重力和麻醉，脊柱侧凸畸形会有一些自发的矫正。方法对12例非麻醉患者在不同体位（站立位（PI）、俯卧位（PII）、俯卧位（PIII）和俯卧位（R-H）对比架（PIV））下的躯干三维几何形状和患者-垫界面压力进行测量。结果俯卧位脊柱高度较站立位显著增加。当使用矫正力躺在DPF上时，患者的横平面畸形和肋骨隆起得到改善，后凸保持更好。与R-H框架相比，肋骨驼峰也有改善。与R-H框架相比，DPF上记录的压力更高，但当使用更大的缓冲垫时，压力降低到相似的值。结论DPF提供了一种新的方法来调整病人的立场，术前和术中。与R-H框架相比，动态患者定位加上施加的矫正力可以增加脊柱侧凸畸形的复位。需要进一步研究以优化衬垫放置，从而确保安全的患者-衬垫界面压力。
Study Design Evaluation of a novel Dynamic Positioning Frame (DPF) for scoliosis surgery to improve presurgical correction. Objective To assess a DPF for scoliosis surgery and demonstrate how its design offers additional presurgical correction of the 3-dimensional deformity. Summary of Background Data Patient positioning is an important step in scoliosis surgery. Although current positioning frames focus on supporting the patient and keeping the abdomen pendulous to reduce blood loss, not much has been carried out to explore the aspect of dynamic positioning during surgery. When lying prone, there is some spontaneous correction of the scoliotic deformity owing to gravity and anesthesia. Methods Trunk 3-dimensional geometry and pressure at the patient-cushion interface were measured for 12 unanesthetized patients in various positions—standing (PI), lying prone on the DPF (PII), lying prone on the DPF with applied corrective forces (PIII), and lying prone on the Relton-Hall (R-H) frame for comparison (PIV). Results Spine height increased significantly in prone as compared with that in standing position. When lying on the DPF with corrective forces, there was an improvement in the patients' transverse plane deformity and rib hump with greater retention of kyphosis. There was also an improvement in the rib hump as compared with that in the R-H frame. Higher pressures were recorded on the DPF as compared with the R-H frame, but were reduced to similar values when larger cushions were used. Conclusions The DPF provides a novel way of modifying the patient's position preoperatively and intraoperatively. Dynamic patient positioning, coupled with applied corrective forces, allows for increased reduction of the scoliotic deformity as compared with the R-H frame. Further investigation is required to optimize cushion placement and thus, insure safe patient-cushion interface pressures.