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术中胸骨垂直位移对脊柱矢状曲线的影响。

The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine.

机构信息

Department of Mechanical Engineering, Ecole Polytechnique de Montréal, P.O. Box 6079, Station Centre-Ville, Montreal, QC H3C3A7, Canada.

出版信息

Eur Spine J. 2010 Mar;19(3):421-6. doi: 10.1007/s00586-009-1199-y. Epub 2009 Nov 10.


DOI:10.1007/s00586-009-1199-y
PMID:19902276
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2899768/
Abstract

Patient positioning is an important step in spinal surgeries. Many surgical frames allow for lumbar lordosis modulation due to lower limb displacement, however, they do not include a feature which can modulate thoracic kyphosis. A sternum vertical displacer (SVD) prototype has been developed which can increase a subject's thoracic kyphosis relative to the neutral prone position on a surgical frame. The kyphosis increase is obtained by lifting the subject's torso off the thoracic cushions with a dedicated sternum cushion that can be displaced vertically. The objective of this study was to evaluate the impact of SVD utilization on the sagittal curves of the spine. Experimental testing was performed on six healthy volunteers. Lateral radiographs were taken in the neutral and sternum raised positions and then analyzed in order to compare the values of sagittal curves. The displacement of volunteers and surgical frame components between positions was recorded using an optoelectronic device. Finally, interface pressures between the volunteers and surgical frame cushions were recorded using a force sensing array. Average results show that passing from the neutral to sternum raised positions caused an increase of 53% in thoracic kyphosis and 24% in lumbar lordosis; both statistically significant. Sensors showed that the sternum was raised a total of 8 cm and that interface pressures were considerably higher in the raised position. The SVD provides a novel way of increasing a patient's thoracic kyphosis intra-operatively which can be used to improve access to posterior vertebral elements and improve sagittal balance. It is recommended that its use should be limited in time due to the increase in interface pressures observed.

摘要

患者体位是脊柱手术的重要步骤。许多手术框架允许通过下肢移位来调节腰椎前凸,但它们不包括可以调节胸椎后凸的功能。已经开发出一种胸骨垂直移位器(SVD)原型,可以增加患者相对于手术框架中立俯卧位的胸椎后凸。通过使用专用胸骨垫将患者的躯干从胸椎垫上提起,可以实现这种后凸增加,该胸骨垫可以垂直移位。本研究的目的是评估 SVD 使用对脊柱矢状曲线的影响。对六名健康志愿者进行了实验测试。在中立位和胸骨抬高位拍摄侧位 X 光片,然后进行分析,以比较矢状曲线的值。使用光电设备记录志愿者和手术框架组件在不同位置之间的位移。最后,使用力感测阵列记录志愿者和手术框架垫之间的界面压力。平均结果表明,从中立位到胸骨抬高位,胸椎后凸增加了 53%,腰椎前凸增加了 24%;均具有统计学意义。传感器显示胸骨总共抬高了 8 厘米,抬高位置的界面压力明显更高。SVD 提供了一种在术中增加患者胸椎后凸的新方法,可以用于改善对后椎体的接近度并改善矢状平衡。由于观察到界面压力增加,建议限制其使用时间。

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The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine.

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本文引用的文献

[1]
Biomechanical study of patient positioning: influence of lower limb positioning on spinal geometry.

J Spinal Disord Tech. 2012-4

[2]
Dynamic positioning of scoliotic patients during spine instrumentation surgery.

J Spinal Disord Tech. 2009-5

[3]
Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches.

Spine (Phila Pa 1976). 2008-11-15

[4]
Biomechanical simulations of scoliotic spine correction due to prone position and anaesthesia prior to surgical instrumentation.

Clin Biomech (Bristol). 2005-11

[5]
Positioning on surgical table.

Eur Spine J. 2004-10

[6]
Sagittal plane correction in idiopathic scoliosis.

Spine (Phila Pa 1976). 2002-4-1

[7]
The lordotic effect of the OSI frame on operative adolescent idiopathic scoliosis patients.

Spine (Phila Pa 1976). 1998-6-15

[8]
The effect of intraoperative hip position on maintenance of lumbar lordosis: a radiographic study of anesthetized patients and unanesthetized volunteers on the Wilson frame.

Spine (Phila Pa 1976). 1997-10-1

[9]
Comparison of lumbar sagittal alignment produced by different operative positions.

Spine (Phila Pa 1976). 1996-8-1

[10]
[Conservative treatment of fractures of the thoracic and lumbar spine].

Z Unfallmed Berufskr. 1972

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