Suppr超能文献

前瞻性评估俯卧位骶骨定位患者的发病率。

Prospective assessment of patient morbidity from prone sacral positioning.

机构信息

Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Neurosurg Spine. 2012 Jan;16(1):51-6. doi: 10.3171/2011.8.SPINE11560. Epub 2011 Sep 30.

Abstract

OBJECT

Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown.

METHODS

The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures.

RESULTS

Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m(2) (range 19.3-43.9 kg/m(2)). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours.

CONCLUSIONS

A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.

摘要

目的

骶骨切除术的定位必须兼顾手术暴露、定位、相关手术程序和患者安全。定位不当可能会增加出血、失明和皮肤破裂的风险。

方法

作者在 2008 年 9 月至 2009 年 8 月期间,对 17 名接受 19 例俯卧位骶骨手术的患者进行了前瞻性研究,这些患者均采用标准化定位方案。关键要素包括颅骨牵引/头部悬吊、开放式透光框架以及广泛的铺巾,以进行相关的闭合和重建手术。

结果

肿瘤包括 5 例脊索瘤、4 例高级别肉瘤、1 例软骨肉瘤、2 例骶前硬膜外黏液乳头状室管膜瘤和 5 例其他肿瘤。患者平均年龄为 49.9 岁(17-74 岁);平均体重指数为 27.6kg/m²(19.3-43.9kg/m²)。术前 Braden 皮肤完整性评分为 21.1(17-23)。平均手术时间为 501 分钟(158-1136 分钟)。8 例患者的手术为前后分期切除术的一部分。13 例患者采用透视定位,4 例患者采用术中 CT 定位。所有影像学研究均成功。1 例患者出现短暂的尺神经麻痹,归因于定位不当。3 例患者(其中 2 例为病态肥胖患者)出现 I 期胸部压疮,另 1 例患者在进行 1136 分钟的手术后出现 II 期压疮。病态肥胖或手术时间超过 10 小时的患者才会出现与定位相关的并发症。

结论

采用开放式透光框架头部悬吊的定位方案有利于进行合理的肿瘤骶骨手术,患者的发病率较低。病态肥胖和手术时间超过 10 小时是与定位相关并发症的危险因素。据作者所知,这是首次在该患者人群中报告手术定位并发症。

文献检索

告别复杂PubMed语法,用中文像聊天一样搜索,搜遍4000万医学文献。AI智能推荐,让科研检索更轻松。

立即免费搜索

文件翻译

保留排版,准确专业,支持PDF/Word/PPT等文件格式,支持 12+语言互译。

免费翻译文档

深度研究

AI帮你快速写综述,25分钟生成高质量综述,智能提取关键信息,辅助科研写作。

立即免费体验