Ueno Takuro, Kabata Tamon, Kajino Yoshitomo, Inoue Daisuke, Ohmori Takaaki, Yoshitani Junya, Ueoka Ken, Yamamuro Yuki, Tsuchiya Hiroyuki
Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan.
Patient Saf Surg. 2020 Apr 7;14:10. doi: 10.1186/s13037-020-00237-7. eCollection 2020.
Intraoperatively acquired pressure ulcers are serious postsurgical complications requiring additional treatment, reoperation, and extended hospitalization. No study has investigated the frequency of the ulcers caused by compression with a pelvic positioner, which is used in hip surgeries to stabilize patients in the lateral decubitus position.
This retrospective study investigated the risk factors and the frequency of the ulcers caused by the use of pelvic positioners in hip surgeries. The records of patients who underwent surgical procedures under general anesthesia at our institution between January 1, 2016 and March 31, 2018 were reviewed. The inclusion criterion for the assessment of risk factors was hip surgery in the lateral decubitus position stabilized by a pelvic positioner. The exclusion criteria were patients with trauma, missing data, or a pre-existing pressure ulcer. Finally,.the study included 229 patients (265 hip surgeries). All the patients were positioned in the lateral decubitus position with the assistance of either a pelvic positioner, which had a single support fixture located over the pubic symphysis or a double support fixture located over the bilateral anterior superior iliac spine. Intraoperatively acquired pressure ulcers were diagnosed when ulcers were absent on admission and the redness that was observed immediately after surgery remained after 24 h. Multivariate analysis was used to identify factors associated with an increased risk for ulcers.
Ulcers developed in 8 of 1810 (0.44%) patients who underwent orthopedic surgery. Seven of the 265 (2.64%) patients who underwent hip surgery in the lateral decubitus position stabilized by a pelvic positioner developed ulcers. All ulcers were located on areas of the body that were compressed by the pelvic positioner. After identifying controls for patient height (less than 154 cm), surgery duration (longer than 180 min), blood loss (more than 355 ml), and type of pelvic positioner used, we identified the independent risk factors for ulcers to be patient height < 154 cm (adjusted odds ratio, 12.8; -value, 0.032) and the use of pelvic positioners with pubic bone support (adjusted odds ratio, 10.53; p-value, 0.047).
The use of pelvic positioners with pubic bone support should be avoided in patients with a height of < 154 cm to decrease the risk of ulcers.
术中获得性压疮是严重的术后并发症，需要额外治疗、再次手术并延长住院时间。尚无研究调查在髋关节手术中用于将患者稳定在侧卧位的骨盆定位器压迫所致压疮的发生率。
这项回顾性研究调查了髋关节手术中使用骨盆定位器所致压疮的危险因素及发生率。回顾了2016年1月1日至2018年3月31日在我院接受全身麻醉手术患者的记录。评估危险因素的纳入标准是采用骨盆定位器稳定在侧卧位的髋关节手术。排除标准为有创伤、数据缺失或术前已有压疮的患者。最终，该研究纳入了229例患者（265例髋关节手术）。所有患者均在骨盆定位器的辅助下处于侧卧位，该定位器要么在耻骨联合上方有一个单一支撑装置，要么在双侧髂前上棘上方有一个双支撑装置。当入院时无溃疡且术后立即观察到的发红在24小时后仍存在时，诊断为术中获得性压疮。采用多因素分析确定与压疮风险增加相关的因素。
在1810例接受骨科手术的患者中，有8例（0.44%）发生了压疮。在265例采用骨盆定位器稳定在侧卧位进行髋关节手术的患者中，有7例（2.64%）发生了压疮。所有压疮均位于被骨盆定位器压迫的身体部位。在确定了患者身高（小于154cm）、手术时间（超过180分钟）、失血量（超过355ml）和所用骨盆定位器类型的对照因素后，我们确定压疮的独立危险因素为患者身高<154cm（调整优势比，12.8；P值，0.032）以及使用带有耻骨支撑的骨盆定位器（调整优势比，10.53；P值，0.047）。
对于身高<154cm的患者，应避免使用带有耻骨支撑的骨盆定位器，以降低压疮风险。
