Peterson M D, Nelson L M, McManus A C, Jackson R P
Medford Orthopaedic Group, Oregon, USA.
Spine (Phila Pa 1976). 1995 Jun 15;20(12):1419-24.
The effect of intraoperative positioning on lumbar lordosis was retrospectively studied by radiographic analysis of 40 patients under general anesthesia.
The aim of this study was to document changes in segmental and total lumbar lordosis between preoperative standing and intraoperative radiographs taken in the "90-90" and prone positions.
Preservation of physiologic lordosis was an important consideration in reconstructive lumbar spine surgery. To avoid iatrogenic loss of lordosis when using spinal instrumentation and to facilitate decompressive procedures, it was necessary to understand how segmental alignments were affected by intraoperative positioning. Although many positioning techniques were used, the effect on lumbar lordosis was not well established.
Preoperative (standing 36" lateral spine) and intraoperative radiographs (lateral lumbar spine L1 to the sacrum) in either the "90-90" position on a Hastings frame (n = 20) or the prone position on a Jackson table (n = 20) were measured twice by two independent observers using Cobb methodology for total and segmental lordosis between L1 and S1. Data were analyzed for intra- and interobserver reliability and changes in segmental and total lordosis between standing and intraoperative radiographs.
Analysis of intra- and interobserver reliability revealed measurements were accurate and reproducible. The "90-90" position produced significant loss (P < or = 0.01) of total and segmental lordosis at all levels except L1-L2, which showed no change. Segmental lordosis was reduced nearly 60% at L2-L3, L3-L4, and L4-L5, and total lordosis was reduced by more than 35%. The prone position on the Jackson table increased segmental lordosis at L5-S1 by 22% (P < or = 0.01) and preserved total and segmental standing lordosis at all other levels.
The "90-90" position on the Hastings frame was associated with significant reduction of total and segmental lordosis in the middle and lower lumbar spine. Positioning prone on a Jackson table maintained standing lumbar lordosis and increased lumbosacral lordosis.
通过对40例全身麻醉患者进行影像学分析，回顾性研究术中体位对腰椎前凸的影响。
本研究旨在记录术前站立位与术中“90-90”位及俯卧位X线片之间节段性和整体腰椎前凸的变化。
在腰椎重建手术中，维持生理前凸是一个重要的考量因素。为避免使用脊柱内固定器械时医源性前凸丢失，并便于减压手术，有必要了解术中体位如何影响节段性排列。尽管使用了多种体位技术，但对腰椎前凸的影响尚未明确。
两名独立观察者使用Cobb法对术前（站立位脊柱36°侧位片）和术中X线片（L1至骶骨的腰椎侧位片）进行两次测量，测量在Hastings框架上的“90-90”位（n = 20）或Jackson手术台上的俯卧位（n = 20）下L1和S1之间的整体和节段性前凸。分析数据的观察者内和观察者间可靠性，以及站立位和术中X线片之间节段性和整体前凸的变化。
观察者内和观察者间可靠性分析显示测量准确且可重复。“90-90”位除L1-L2节段无变化外，所有节段的整体和节段性前凸均显著丢失（P≤0.01）。L2-L3、L3-L4和L4-L5节段性前凸减少近60%，整体前凸减少超过35%。Jackson手术台上的俯卧位使L5-S1节段性前凸增加22%（P≤0.01），并在所有其他节段维持整体和节段性站立前凸。
Hastings框架上的“90-90”位与中下段腰椎整体和节段性前凸的显著降低相关。俯卧于Jackson手术台上可维持站立位腰椎前凸并增加腰骶段前凸。
