Baird Brandon J, Tynan Monica A, Tracy Lauren F, Heaton James T, Burns James A
Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, U.S.A.
Laryngoscope. 2021 Dec;131(12):2752-2758. doi: 10.1002/lary.29717. Epub 2021 Jul 23.
While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings.
Prospective cohort study.
Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso.
The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly.
Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs.
3 Laryngoscope, 131:2752-2758, 2021.
虽然人们认识到，进行显微喉手术的耳鼻喉科医生可能会因相对于患者的身体姿势欠佳而出现肌肉骨骼症状，但可弯曲喉镜检查和清醒喉手术（ALS）也可能带来人体工程学风险。本前瞻性研究使用人体工程学分析、皮肤表面肌电图（EMG）和自我报告的疼痛评分，测量了喉镜检查期间人体工程学良好和不良姿势的影响。
前瞻性队列研究。
八名接受过喉镜检查培训的参与者，相对于模拟患者，在三个不同高度（中立位——患者头顶与检查者肩部齐平、高位——比中立位高6英寸、低位——比中立位低6英寸）采取四种人体工程学上不同的站立姿势（侧面/近侧、侧面/远侧、正面/近侧、正面/远侧）。使用经过验证的快速上肢评估（RULA，1[最佳]至7[最差]）工具对参与者在这12种姿势下的姿势进行分析。然后，参与者在不良姿势（低位-侧面-远侧）和良好姿势（中立位-正面-近侧）下模拟ALS 10分钟，在四肢和躯干上放置12个EMG传感器。
RULA评分最差的姿势是侧面/近侧/高位（7.0），最佳姿势是正面/近侧/中立位（4.5）。EMG测量结果显示，不良姿势和良好姿势下的模拟手术之间存在显著差异，与良好姿势相比，不良姿势在所有采样肌肉上引发的EMG均方根幅值平均高出206%（配对t检验，自由度=7，P<.01），这与姿势不佳时自我报告的疲劳/疼痛情况一致。
定量和定性测量结果证明了模拟喉镜检查期间外科医生姿势的影响，并提出了对人体工程学有益的姿势，这种姿势应有助于ALS。
3 《喉镜》，131:2752 - 2758，2021年。
