Batra Anjay K, Brusalis Christopher M, Jawanda Harkirat, Jackson Garrett, Verma Nikhil N
Division of Sports Medicine, Department of Orthopaedic Surgery, RUSH University Medical Center/Midwest Orthopaedics at RUSH, Chicago, Illinois, USA.
Video J Sports Med. 2023 Jun 27;3(3):26350254231169488. doi: 10.1177/26350254231169488. eCollection 2023 May-Jun.
Lateral decubitus positioning is a frequently employed technique to perform shoulder arthroscopy. Proper patient positioning and equipment setup is crucial to ensure a safe and efficient surgery.
The common indications for performing a shoulder arthroscopy in the lateral decubitus position include anterior shoulder stabilization, posterior shoulder stabilization, superior labrum anterior to posterior (SLAP) repair, diagnostic arthroscopy for internal impingement, and arthroscopic capsular release for adhesive capsulitis.
After undergoing general endotracheal anesthesia in the supine position on a standard operating room table, the patient is rotated into the lateral decubitus position with the operative arm facing upward. The patient's head is supported with a pillow to ensure a neutral position. The nonoperative arm is flexed forward and rests on a padded arm board. The sides of a bean bag are applied to the patient's torso to maintain the lateral decubitus position, and the bean bag is deflated to remain rigid. An axillary roll is placed under the axilla, and foam pads are placed below the "down leg" and between both legs. A commercial arm jack is positioned on the anterior, proximal side of the operating room table to allow for 20° of shoulder abduction, which maximizes the glenohumeral joint space.
Advantages of the lateral decubitus position over the beach chair position include improved access to the anterior, inferior, and posterior glenoid; more ergonomic positioning for the operating surgeon; lower risk for patient cerebral hypoperfusion; and reduced rates of recurrent instability following arthroscopic stabilization in comparison to procedures performed in the beach chair position. Disadvantages of the lateral decubitus position include risk of traction-related neurovascular injury, requirement of an arm suspension device, and increased difficulty in rotating the shoulder intraoperatively.
DISCUSSION/CONCLUSION: Lateral decubitus positioning is commonly used to achieve a circumferential view of the glenohumeral joint in shoulder arthroscopy. This surgical position yields several advantages for the operating surgeon and has been shown to be associated with improved clinical outcomes after shoulder instability surgery.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
侧卧位是进行肩关节镜检查常用的技术。正确的患者体位和设备设置对于确保手术安全和高效至关重要。
在侧卧位进行肩关节镜检查的常见适应症包括肩关节前侧稳定、后侧稳定、前后上盂唇（SLAP）修复、内部撞击的诊断性关节镜检查以及粘连性关节囊炎的关节镜下关节囊松解。
患者在标准手术台上仰卧位接受全身气管内麻醉后，旋转至侧卧位，手术侧手臂向上。用枕头支撑患者头部以确保中立位。非手术侧手臂向前屈曲并置于有衬垫的臂板上。将豆袋的两侧贴于患者躯干以维持侧卧位，豆袋放气后保持坚硬。在腋窝下放置一个腋垫，在“下方腿部”下方和双腿之间放置泡沫垫。在手术台的前侧近端放置一个商用臂托，使肩部外展20°，以最大限度地扩大盂肱关节间隙。
与沙滩椅位相比，侧卧位的优点包括更便于进入肩胛盂的前侧、下侧和后侧；手术医生的体位更符合人体工程学；患者脑灌注不足的风险更低；与在沙滩椅位进行的手术相比，关节镜稳定术后复发性不稳定的发生率更低。侧卧位的缺点包括有牵引相关神经血管损伤的风险、需要手臂悬吊装置以及术中旋转肩部的难度增加。
讨论/结论：侧卧位常用于在肩关节镜检查中获得盂肱关节的全景视野。这种手术体位对手术医生有几个优点，并且已被证明与肩关节不稳定手术后改善的临床结果相关。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
