Saiwai Hirokazu, Okada Seiji, Kawaguchi Ken-Ichi, Saito Takeyuki, Hayashida Mitsumasa, Matsushita Akinobu, Matsumoto Yoshihiro, Nakashima Yasuharu
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan; Department of Immunobiology and Neuroscience, Medical Institute of Bioregulation, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Clin Neurosci. 2019 May;63:227-230. doi: 10.1016/j.jocn.2019.01.047. Epub 2019 Feb 15.
Surgery in the prone position is associated with a variety of complications due to the positioning, including the widely recognized peripheral nerve compression injuries and brachial plexus neuropathy. Previous studies have reported that thin body habitus is a predisposing risk factor for the compressive peripheral nerve injuries due to the prone position surgery. However, prone-position-related brachial plexus injury in patients who are overweight due to hypertrophic muscles have never been reported. Here we report a case of a professional sumo wrestler with severe thoracic ossification of the posterior longitudinal ligament (OPLL). Thoracic OPLL was successfully treated by posterior spinal fusion and decompression surgery. Despite a preoperative simulation and intraoperative inspection of the patient's surgical positioning, he suffered from bilateral upper extremity paralysis immediately after the surgery. Postoperative axillary MRI image revealed a high-intensity area on both sides of his pectoral muscles and axillary fossa, which implied that the pectoral muscles between the ribs and chest pad were pushed out toward the axillary fossa, resulting in compressive brachial plexus injury. His upper extremity motor paralysis was fully recovered in 6 months, but he still has mild tingling sensation even after 12 months of his surgery. In conclusion, overweight patients with hypertrophic muscles pose a risk for brachial plexus entrapment injury by pectoral muscles during prone-position surgery, and therefore it would be more effective to use a wide chest pad to reduce the pressure on the pectoral muscles to prevent it from being pushed out toward the axillary fossa.
俯卧位手术会因体位引发多种并发症，包括广为人知的周围神经压迫损伤和臂丛神经病变。既往研究报道，体型消瘦是俯卧位手术导致周围神经压迫损伤的一个易感风险因素。然而，因肌肉肥厚而超重的患者在俯卧位手术中发生与体位相关的臂丛神经损伤尚未见报道。在此，我们报告一例患有严重胸段后纵韧带骨化（OPLL）的职业相扑选手病例。胸段OPLL通过后路脊柱融合减压手术成功治疗。尽管术前对患者手术体位进行了模拟和术中检查，但术后他立即出现双侧上肢麻痹。术后腋窝MRI图像显示其双侧胸肌和腋窝处有高强度区域，这意味着肋骨与胸垫之间的胸肌被挤向腋窝，导致臂丛神经受压损伤。他的上肢运动麻痹在6个月时完全恢复，但术后12个月仍有轻度刺痛感。总之，肌肉肥厚的超重患者在俯卧位手术中存在胸肌导致臂丛神经卡压损伤的风险，因此使用宽胸垫减轻胸肌压力以防止其被挤向腋窝可能会更有效。
