Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
Eur Spine J. 2014 May;23(5):1067-76. doi: 10.1007/s00586-013-3125-6. Epub 2013 Dec 24.
Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope.
We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position.
Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus.
This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue.
从人体工程学角度研究手术中外科医生的脊柱角度，研究外科医生脊柱的运动学与肌肉骨骼疲劳和疼痛的关系。脊柱角度因手术台高度和可视化方法而异，在之前的一篇论文中我们表明，使用手术显微镜和手术台高度在脐与胸骨之间的中点是减少肌肉骨骼负荷的最佳选择。然而，以前没有研究包括手术显微镜作为可能的可视化方法。本研究的目的是评估手术台高度和可视化方法（包括手术显微镜）对外科医生脊柱角度的影响。
我们招募了 18 名经验丰富的脊柱外科医生进行这项研究，每位医生都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区域（肉眼、手术显微镜）和三种不同的手术台高度（髂前上棘、脐、脐与胸骨中点）进行研究。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 个摄像头光电运动分析系统，从头部到骨盆放置 16 个标记。比较了不同手术台高度和可视化方法以及自然站立位置下的腰椎前凸、胸椎后凸、颈椎前凸和枕骨角度。
可视化方法对整个脊柱角度有显著影响。使用手术显微镜进行椎间盘切除术时，所有参数更接近自然站立值，且与肉眼观察相比没有差异。手术台高度也会影响整个脊柱角度，随着手术台高度的增加，与自然站立位置的差异逐渐减小，与可视化方法无关。使用手术显微镜时，在脐以上的手术台高度下，腰椎前凸、胸椎后凸和颈椎前凸无差异。
本研究表明，使用手术显微镜和手术台高度在脐以上是减少外科医生肌肉骨骼疲劳的最佳选择。
