Department of Orthopaedics, Scoliosis Research Institute, Guro Hospital, Korea University, Guro Dong 80, Guro-gu, Seoul, Korea.
Eur Spine J. 2013 May;22 Suppl 3(Suppl 3):S491-6. doi: 10.1007/s00586-013-2696-6. Epub 2013 Mar 17.
To report a complication of airway obstruction during spinal deformity correction surgery in Duchenne muscular dystrophy (DMD) patient, due to lordoscoliosis, airway malacia, and prone surgical positioning, which was rectified by changing the position of the patient and surgery was successfully completed.
A 15-year-old boy was diagnosed with DMD and admitted for surgical treatment of thoracolumbar scoliosis. The patient's preoperative Cobb's angle was 79° and the kyphotic angle was -19°. During the initial period of surgery, while in the prone position, peak inspiratory pressure (PIP) suddenly increased from 20-21 to 38-41 cmH2O, wheezing sounds were heard on auscultation of both lungs, and his blood pressure began to fall. Under suspicion of airway problem, intraoperative fiberoptic bronchoscopy was performed which confirmed airway obstruction. Attributing patient's prone position as the cause of airway obstruction, the surgical position of the patient was changed from prone to semi-lateral. After this change, the PIP stabilized to within normal limits (20-23 cmH2O). The surgical correction was successfully completed with a posterior-only pedicle screw by the free-hand technique, with the patient in the semi-lateral position for the rest of surgery.
Lordoscoliosis and airway malacia in a patient with DMD can lead to occlusion of the tracheobronchial lumen when the patient is in the prone position. Changing the patient's position from prone to semi-lateral can be of help to reverse this airway obstruction and complete the surgery. Pedicular screw insertion can be safely and effectively carried out in this position using free-hand technique.
报告一例杜氏肌营养不良症（DMD）患者脊柱畸形矫正术中气道阻塞的并发症，该患者因脊柱后凸、气道软化和俯卧手术体位导致气道阻塞，通过改变患者体位，手术成功完成。
一名 15 岁男孩被诊断为 DMD，并入院接受胸腰椎脊柱侧凸的手术治疗。患者术前 Cobb 角为 79°，后凸角为-19°。手术初期，患者处于俯卧位时，吸气峰压（PIP）突然从 20-21 增加到 38-41cmH2O，双肺听诊可闻及喘鸣音，血压开始下降。怀疑存在气道问题，术中进行了纤维支气管镜检查，证实存在气道阻塞。考虑到患者俯卧位是气道阻塞的原因，将患者的手术体位从俯卧位改为半侧卧位。改变体位后，PIP 稳定在正常范围内（20-23cmH2O）。手术采用徒手技术通过后路单纯椎弓根螺钉完成矫正，患者在手术剩余时间保持半侧卧位。
DMD 患者脊柱后凸和气道软化可导致患者俯卧位时气管支气管腔阻塞。将患者体位从俯卧位改为半侧卧位有助于逆转气道阻塞并完成手术。在该体位下，使用徒手技术可以安全有效地进行椎弓根螺钉插入。
