Pang Long, Watanabe Kota, Toyama Yoshiaki, Matsumoto Morio
Department of Orthopedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan.
Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan.
Scoliosis. 2014 Oct 25;9:17. doi: 10.1186/1748-7161-9-17. eCollection 2014.
Gelpi retractors are used in surgery because they can reduce paravertebral muscle damage during retraction. No pleural injuries associated with their use in posterior spine surgery have been reported.
To describe a patient who suffered a massive postoperative hemothorax caused by a Gelpi retractor used during posterior correction surgery for adolescent idiopathic scoliosis (AIS).
Case report.
A case report of a rare hemothorax complication due to a Gelpi retractor is reported. The relevant literature was reviewed.
A 12-year-old girl with Lenke type 2 AIS, with curves of 60° at T2-7 and 75° at T7-L1, underwent posterior correction and fusion surgery using a segmental pedicle screw construct placed between T2 and L2. Although the patient's vital signs were stable during and soon after the surgery, a chest x-ray taken one day later revealed a massive left hemothorax. Her hemoglobin concentration was decreased to 5.5g/dl, and SpO2 remained as low as 92% even with oxygen administration. Thoracoscopy revealed subpleural hemorrhaging at several points in the left upper intercostal area (T3-6), and a penetration of the pleura between the left 4th and 5th ribs. Active bleeding had already stopped. The tip of the Gelpi retractor appeared to have penetrated the pleura. A chest tube was placed in the patient to treat the hemothorax.
A pleural injury by the Gelpi retractor was determined to be the cause of the hemothorax in this case. The patient's prominent thoracic hump may have increased the risk of such an injury because the tip of a Gelpi retractor might easily have become stuck in the intercostal space rather than the paravertebral muscles.
Gelpi牵开器用于手术，因为它们在牵开过程中可减少椎旁肌损伤。尚未有在脊柱后路手术中使用该牵开器导致胸膜损伤的报道。
描述一名在青少年特发性脊柱侧凸（AIS）后路矫正手术中使用Gelpi牵开器后发生大量术后血胸的患者。
病例报告。
报告一例因Gelpi牵开器导致罕见血胸并发症的病例报告。并对相关文献进行了综述。
一名12岁Lenke 2型AIS女孩，T2 - 7节段侧弯60°，T7 - L1节段侧弯75°，接受了T2至L2节段椎弓根螺钉置入的后路矫正融合手术。尽管患者在手术期间及术后不久生命体征稳定，但术后一天拍摄的胸部X光片显示左侧大量血胸。她的血红蛋白浓度降至5.5g/dl，即使吸氧SpO2仍低至92%。胸腔镜检查发现左上肋间区域（T3 - 6）多个点有胸膜下出血，左侧第4和第5肋骨之间的胸膜有一处穿透。活动性出血已停止。Gelpi牵开器的尖端似乎穿透了胸膜。为该患者放置了胸腔引流管以治疗血胸。
在本病例中，确定Gelpi牵开器导致的胸膜损伤是血胸的原因。患者明显的胸段驼背可能增加了这种损伤的风险，因为Gelpi牵开器的尖端可能很容易卡在肋间间隙而不是椎旁肌中。
