Department of Orthopaedics and Traumatology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Clin Orthop Relat Res. 2010 Dec;468(12):3415-8. doi: 10.1007/s11999-010-1317-5. Epub 2010 Mar 19.
Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.
We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe tracheal stenosis and ankylosing spondylitis making general endotracheal and conventional neuraxial anesthesia nearly impossible.
Possible alternative anesthetic approaches described in the literature include awake fiberoptic bronchoscopic guided intubation, laryngeal mask airway, and caudal anesthesia.
We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA.
矫形外科医生经常会遇到患有强直性脊柱炎的患者，这些患者需要进行各种类型的下肢手术；然而，其中一些患者会给麻醉师带来挑战。
我们报告了一例 65 岁患者的病例，该患者在接受骨水泥全髋关节置换术 30 年后，股骨部件发生骨折。该患者存在严重的气管狭窄和强直性脊柱炎，这使得全身气管内插管和常规神经轴麻醉几乎不可能进行。
文献中描述的其他可能的麻醉方法包括清醒纤维支气管镜引导插管、喉罩气道和骶管麻醉。
我们通过在局部麻醉下进行脊柱椎板切开术，随后插入脊髓导管并注入麻醉剂，成功地为该患者实施了麻醉。松动的部件被更换为非骨水泥全髋关节置换术。
