Tatsumi Robert Louis
Northwest Spine Research Foundation, Tualatin, OR.
Int J Spine Surg. 2015 Sep 28;9:48. doi: 10.14444/2048. eCollection 2015.
The lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive procedure that has become widely utilized. The LLIF procedure typically involves bending the table to access the disc spaces of interest due to anatomical constraints. It is unknown if this bending process is painful or what pressures are exhibited on the downside part of the body. The goal of the study was to determine whether sex, height, weight, body mass index, bed angle, or positioning relative to the break of the bed affects the downside skin pressures and VAS pain scores in awake volunteers.
Fifty-six volunteers were placed in the lateral decubitus position and pressure sensors were placed at the downside part of their anatomy (shoulder, T10 rib , iliac crest, and greater trochanter). The pressures were checked with the iliac crest or greater trochanter at 0, 10, 20, 30, 40 degree bed angles. VAS scores were checked when the iliac crest or greater trochanter were at the maximum bed break angles.
A significant positive association was found between increased bed angle and pressure at all five areas on the downside body locations (p<0.0001). The greatest pressures were located at the iliac crest and greater trochanter when these specific locations were centered over the break of the bed (p<0.0001). When the iliac crest was placed at maximal bed break, each unit increase in BMI increased the VAS pain by 0.13 (p<0.0001)and men had 1.96 (p=0.0009)higher VAS scores then women. When the greater trochanter was placed at the maximal bed break, each unit increase in BMI decreased VAS pain by 0.19 (p<0.0001) and women had 1.55 (p=0.0002)higher VAS pain scores then men.
In awake volunteers, the pressure at the iliac crest or greater trochanter at the break of the bed increases by increasing the bed angle. Women with a lower BMI had high VAS pain scores when their greater trochanter was at maximal bed break. Men with higher BMI had high VAS pain scores when their iliac crest was at maximal bed break. An awareness of the iliac crest or greater trochanter at the break of the bed should be considered to prevent pain and increased pressure based on the patient's sex and BMI.
腰椎外侧椎间融合术（LLIF）是一种已被广泛应用的微创手术。由于解剖学限制，LLIF手术通常需要弯曲手术台以进入感兴趣的椎间盘间隙。目前尚不清楚这种弯曲过程是否会引起疼痛，以及身体下方部位会承受何种压力。本研究的目的是确定性别、身高、体重、体重指数、床角度或相对于床断点的体位是否会影响清醒志愿者身体下方皮肤压力和视觉模拟评分（VAS）疼痛评分。
56名志愿者被置于侧卧位，压力传感器放置在其身体下方部位（肩部、第10肋、髂嵴和大转子）。在床角度为0、10、20、30、40度时，检查髂嵴或大转子处的压力。当髂嵴或大转子处于最大床断点角度时，检查VAS评分。
发现床角度增加与身体下方所有五个区域的压力之间存在显著正相关（p<0.0001）。当这些特定部位位于床断点上方时，最大压力位于髂嵴和大转子处（p<0.0001）。当髂嵴处于最大床断点时，BMI每增加一个单位，VAS疼痛增加0.13（p<0.0001），男性的VAS评分比女性高1.96（p=0.0009）。当大转子处于最大床断点时，BMI每增加一个单位，VAS疼痛降低0.19（p<0.0001），女性的VAS疼痛评分比男性高1.55（p=0.0002）。
在清醒志愿者中，通过增加床角度，床断点处髂嵴或大转子的压力会增加。当大转子处于最大床断点时，BMI较低的女性VAS疼痛评分较高。当髂嵴处于最大床断点时，BMI较高的男性VAS疼痛评分较高。应考虑到床断点处的髂嵴或大转子，根据患者的性别和BMI预防疼痛和压力增加。
