Roush T F, Crawford A H, Berlin R E, Wolf R K
Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):448-50. doi: 10.1097/00007632-200102150-00024.
This case report illustrates the occurrence of intraoperative tension pneumothorax, a previously unreported complication occurring during anterior instrumentation for correction of scoliosis by video-assisted surgery.
To demonstrate a consequence of overadvancement of a Steinmann pin (guide wire).
Although intraoperative tension pneumothorax is admitted to be a theoretical complication of video-assisted surgery for anterior correction of idiopathic scoliosis, there has yet to be a case reported in the literature. This report presents the first case of this complication.
A 13-year-old girl who had right thoracic scoliosis with a curve measuring 54 degrees underwent video-assisted surgery discectomy and anterior spinal fusion with instrumentation of T5 through T11. Single-lung ventilation had been achieved with a double-lumen tube and the right lung was deflated. After approximately 4.5 hours of complication-free surgery, intraoperative fluoroscopy showed an approximately 2-cm overadvancement of a guide wire into the opposite hemithorax. Approximately 5 minutes after the overadvancement was corrected, the patient experienced a gradual increase in heart rate and a corresponding gradual decrease in oxygen saturation and both systolic and diastolic blood pressures. Approximately 35 minutes later, it was determined that the patient had sustained a tension pneumothorax of the left hemithorax.
The patient underwent urgent partial reinflation of the right lung and a tube thoracostomy of the left thoracic cavity. Vital signs quickly returned to stable levels, and the left lung easily reinflated with the chest tube suction. The patient remained stable after the procedure was resumed (by right lung deflation). The remainder of the surgery and the postoperative course were uneventful.
Although video-assisted surgery continues to gain popularity in the management of spinal deformities, the surgical team must be certain to pay meticulous attention to detail throughout the procedure. The early detection and treatment of complications can be life-preserving.
本病例报告阐述了术中张力性气胸的发生情况，这是一种在电视辅助手术矫正脊柱侧弯前路内固定术中未曾报道过的并发症。
证明斯氏针（导丝）过度推进的后果。
尽管术中张力性气胸被认为是电视辅助特发性脊柱侧弯前路矫正手术的一种理论上的并发症，但文献中尚未有病例报道。本报告呈现了该并发症的首例病例。
一名13岁患有右侧胸段脊柱侧弯、侧弯角度为54度的女孩接受了电视辅助手术下的椎间盘切除术及T5至T11节段的前路脊柱融合内固定术。使用双腔管实现了单肺通气，右肺萎陷。在无并发症的手术进行约4.5小时后，术中透视显示一根导丝向对侧胸腔过度推进了约2厘米。在过度推进被纠正后约5分钟，患者心率逐渐升高，氧饱和度以及收缩压和舒张压相应逐渐下降。约35分钟后，确定患者发生了左半侧胸腔的张力性气胸。
患者接受了右肺紧急部分复张及左胸腔胸腔闭式引流术。生命体征迅速恢复到稳定水平，通过胸腔闭式引流管抽吸，左肺很容易复张。在恢复手术（通过右肺萎陷）后患者保持稳定。手术的其余部分及术后过程均顺利。
尽管电视辅助手术在脊柱畸形治疗中越来越受欢迎，但手术团队在整个手术过程中必须确保对细节给予细致关注。并发症的早期发现和治疗可以挽救生命。
