Bonnaig Nicolas, Dailey Steven, Archdeacon Michael
1363 Coppershire Cove South, Apt. 104, Germantown, TN 38138.
UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:
J Bone Joint Surg Am. 2014 Jul 2;96(13):1135-1140. doi: 10.2106/JBJS.M.01267.
➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible.
➤ 术中不当体位的后果可能很严重：不仅可能导致严重的发病情况，还可能成为主要的诉讼领域，尤其是当发生周围神经损伤时。
➤ 尺神经最有可能因不当体位而受损。术中肘部应屈曲≤90°，前臂置于中立位或轻度旋后位，以尽量减少肘管内的压力。
➤ 通过使用足够的衬垫，最好避免与压力相关的并发症，如压疮和脱发。手术室手术台和扶手的垫子应着重放在骨隆突处。
➤ 将头部置于非中立位或手臂外展≥90°可能导致臂丛神经损伤。
➤ 半侧卧位会增加未受伤侧腿部的骨筋膜室内压力。如果可能，避免采用此体位可将健侧小腿骨筋膜室综合征的风险降至最低。
