Ikuma Hisanori, Hirose Tomohiko, Takao Shinichiro, Ueda Masataka, Yamashita Kazutaka, Otsuka Kazutoshi, Kawasaki Keisuke
1Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Kagawa.
2Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama; and.
J Neurosurg Spine. 2021 Nov 26;36(5):784-791. doi: 10.3171/2021.8.SPINE21996. Print 2022 May 1.
Patients with ankylosing spinal disorders (ASDs), such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, often have rigid kyphosis of the spine. The fracture site is sometimes unintentionally displaced when surgery is conducted with the patient prone. To prevent this incident, the authors adopted the lateral decubitus position for patients intraoperatively for this pathology. The aim of this study was to retrospectively assess the impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fractures with ASD.
Thirty-seven consecutive patients who underwent posterior instrumentation for thoracolumbar fracture with ASD at the authors' institute were divided into 15 lateral decubitus positions (group L) and 22 prone positions (group P). Surgical time, estimated blood loss (EBL), number of levels fused, perioperative complications, length of stay (LOS), ratio of fracture voids, and ratio of anterior wall height were investigated. The ratio of fracture void and the ratio of anterior wall height were the radiological assessments showing a degree of reduction in vertebral fracture on CT.
Age, sex, BMI, fracture level, and LOS were similar between the groups. Levels fused and EBL were significantly shorter and less in group L (p < 0.001 and p = 0.04), but there was no significant difference in surgical time. The complication rate was similar, but 1 death within 90 days after surgery was found in group P. The ratio of fracture voids was 85.4% ± 12.8% for group L and 117.5% ± 37.3% for group P. A significantly larger number of patients with a fracture void ratio of 100% or less was found in group L (86.7% vs 36.4%, p = 0.002). The ratio of anterior wall height was 107.5% ± 12.3% for group L and 116.9% ± 18.8% for group P. A significantly larger number of patients with the anterior wall height ratio of 100% or less was also found in group L (60.0% vs 27.3%, p = 0.046).
The results of this study suggest that the lateral decubitus position can be expected to have an effect on closing or maintaining the fracture void or a preventive effect of intraoperative unintentional extension displacement of the fractured site, which is often seen in the prone position during surgery for thoracolumbar fractures involving ASD.
患有强直性脊柱疾病（ASD）的患者，如强直性脊柱炎和弥漫性特发性骨肥厚，常伴有脊柱僵硬性后凸。当患者俯卧位进行手术时，骨折部位有时会意外移位。为防止这种情况发生，作者在手术中针对该病理情况采用了侧卧位。本研究的目的是回顾性评估侧卧位在围手术期对ASD伴胸腰椎骨折后路固定的影响。
在作者所在机构连续接受ASD伴胸腰椎骨折后路内固定的37例患者被分为15例侧卧位组（L组）和22例俯卧位组（P组）。对手术时间、估计失血量（EBL）、融合节段数、围手术期并发症、住院时间（LOS）、骨折空洞比例和前壁高度比例进行了研究。骨折空洞比例和前壁高度比例是在CT上显示椎体骨折复位程度的影像学评估指标。
两组患者的年龄、性别、BMI、骨折节段和LOS相似。L组的融合节段数和EBL显著更短且更少（p < 0.001和p = 0.04），但手术时间无显著差异。并发症发生率相似，但P组在术后90天内有1例死亡。L组的骨折空洞比例为85.4%±12.8%，P组为117.5%±37.3%。L组骨折空洞比例为100%或更低的患者数量显著更多（86.7%对36.4%，p = 0.002）。L组的前壁高度比例为107.5%±12.3%，P组为116.9%±18.8%。L组前壁高度比例为100%或更低的患者数量也显著更多（60.0%对27.3%，p = 0.046）。
本研究结果表明，对于涉及ASD的胸腰椎骨折手术，侧卧位有望对闭合或维持骨折空洞产生影响，或对手术中俯卧位时常见的骨折部位术中意外伸展移位具有预防作用。
