Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211, Eonju-ro Gangnam-gu, Seoul 135-720, South Korea.
Eur Spine J. 2012 Dec;21(12):2704-12. doi: 10.1007/s00586-012-2425-6. Epub 2012 Jul 10.
The ergonomic problems for surgeons during spine surgery are an awkward body posture, repetitive movements, increased muscle activity, an overflexed spine, and a protracted time in a standing posture. The authors analyzed whole spine angles during discectomy. The objective of this study is to assess differences in surgeon whole spines angles according to operating table height and the methods used to visualize surgical field.
A cohort of 12 experienced spine surgeons was enrolled. Twelve experienced spine surgeons performed discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, and out of loupe) and three different operating table heights. Whole spine angles were compared for three different views during discectomy simulation; midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from head to pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared at the different operating table heights, while using the three visualization methods, with natural standing position.
Whole spine angles were significantly different for visualization methods. Lumbar lordosis, cervical lordosis, and occipital angle were closer to natural standing values when discectomy was performed with a loupe, but most measures differed from natural standing values when performed out of loupe. Thoracic kyphosis was also similar to the natural standing position during discectomy using a loupe, but differed from the natural standing position when performed with naked eye. Whole spine angles were also found to differ from the natural standing position according to operating table height, and became closer to natural standing position values as operating table height increased, when simulation was conducted with loupe.
This study suggests that loupe use and a table height midpoint between the umbilicus and sternum are optimal for reducing surgeon musculoskeletal fatigue.
脊柱手术中外科医生的人体工程学问题包括姿势别扭、动作重复、肌肉活动增加、脊柱过度弯曲和长时间站立。作者分析了椎间盘切除术中的整个脊柱角度。本研究的目的是根据手术台高度和用于可视化手术视野的方法评估外科医生整个脊柱角度的差异。
招募了一组 12 名经验丰富的脊柱外科医生。12 名经验丰富的脊柱外科医生使用脊柱手术模拟器进行椎间盘切除术。使用三种不同的方法来可视化手术视野（肉眼、手术放大镜和手术放大镜外）和三种不同的手术台高度。在椎间盘切除术模拟过程中，比较了三种不同视图下的整个脊柱角度；中线、同侧和对侧。使用 16 个摄像机光电运动分析系统，从头部到骨盆放置 16 个标记。在使用三种可视化方法时，比较了不同手术台高度下的腰椎前凸、胸椎后凸、颈椎前凸和枕骨角度，以及自然站立位置。
可视化方法的整个脊柱角度差异显著。使用手术放大镜进行椎间盘切除时，腰椎前凸、颈椎前凸和枕骨角度更接近自然站立值，但在使用手术放大镜外时，大多数测量值与自然站立值不同。使用手术放大镜进行椎间盘切除时，胸椎后凸也与自然站立位置相似，但使用肉眼时则与自然站立位置不同。根据手术台高度，整个脊柱角度也与自然站立位置不同，当使用手术放大镜进行模拟时，手术台高度越高，整个脊柱角度越接近自然站立位置。
本研究表明，使用手术放大镜和手术台高度在脐与胸骨之间的中点可以优化减少外科医生肌肉骨骼疲劳。
