DePasse J Mason, Palumbo Mark A, Haque Maahir, Eberson Craig P, Daniels Alan H
J Mason DePasse, Mark A Palumbo, Maahir Haque, Craig P Eberson, Alan H Daniels, Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States.
World J Orthop. 2015 Apr 18;6(3):351-9. doi: 10.5312/wjo.v6.i3.351.
Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity. Although many of these complications remain uncommon, the range of possible morbidities is wide and includes multiple organ systems. Perioperative visual loss (POVL) is a well described, but uncommon complication that may occur due to ischemia to the optic nerve, retina, or cerebral cortex. Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery. Peripheral nerve injuries, such as those caused by prolonged traction to the brachial plexus, are more commonly encountered postoperative events. Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning, albeit rarely. Other uncommon positioning complications such as tongue swelling resulting in airway compromise, femoral artery ischemia, and avascular necrosis of the femoral head have also been reported. Many of these are well-understood and largely avoidable through thoughtful attention to detail. Other complications, such as POVL, remain incompletely understood and thus more difficult to predict or prevent. Here, the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.
择期脊柱手术中俯卧位手术体位相关并发症有可能导致严重的患者发病。尽管其中许多并发症并不常见，但可能的发病范围很广，涉及多个器官系统。围手术期视力丧失（POVL）是一种已被充分描述但并不常见的并发症，可能由于视神经、视网膜或大脑皮质缺血而发生。闭角型青光眼和黑矇已被报道为脊柱手术后视力丧失的其他病因。周围神经损伤，如臂丛神经长时间牵拉所致损伤，是更常见的术后事件。包括压疮和骨筋膜室综合征在内的肌皮并发症在俯卧位后也可能发生，尽管很少见。其他不常见的体位并发症，如导致气道受压的舌肿胀、股动脉缺血和股骨头缺血性坏死也有报道。其中许多并发症已为人所熟知，通过对细节的精心关注在很大程度上是可以避免的。其他并发症，如POVL，仍未被完全理解，因此更难以预测或预防。在此，对当前关于脊柱手术俯卧位并发症的文献进行综述，以提高对潜在并发症范围的认识，并为脊柱外科医生提供将俯卧位患者发病风险降至最低的策略。
