Warner M A, Martin J T, Schroeder D R, Offord K P, Chute C G
Mayo Medical School, Rochester, Minnesota 55905.
Anesthesiology. 1994 Jul;81(1):6-12. doi: 10.1097/00000542-199407000-00004.
Motor neuropathy of a lower extremity is well-recognized as a potential complication of procedures performed on patients in a lithotomy position. Most of this awareness is based on anecdotal reports, however, and the incidence and risk factors for this complication have not been reported.
We retrospectively reviewed the perioperative courses of 198,461 consecutive patients who underwent 1 of 56 surgical procedures historically performed on patients in a lithotomy position at the Mayo Clinic, Rochester, Minnesota, from 1957 to 1991 inclusive. The medical diagnoses of patients who had procedures in a lithotomy position were scanned for 26 diagnoses associated with neuropathy. Persistent neuropathy of the lower extremity was defined as a motor deficit of at least 3 months' duration. Risk factors anecdotally associated with persistent neuropathy were analyzed by comparing identified cases of neuropathy to controls in a 1:3 case-control study.
Persistent neuropathies after procedures performed on patients in a lithotomy position were identified in 55 cases for a rate of 1 per 3,608. Multivariate risk factors for development of a persistent neuropathy of a lower extremity included duration in lithotomy of 4 h or longer, a body mass index (kilograms per squared meter) of 20 or less, and a history of smoking within 30 days of the procedure. Regional anesthetic techniques were not found to be associated with an increased risk of neuropathy. Of the 53 patients who lived at least 1 yr after their procedure, 24 (45%) required either prosthetic or ambulatory support for persistent foot drop or leg weakness.
These data suggest that prolonged duration in lithotomy and patient risk factors, including very thin body habitus and smoking in the preoperative period, are associated with the development of a lower-extremity neuropathy after procedures performed on patients in a lithotomy position. A reduction of time in the lithotomy position may be particularly worthwhile for patients with these risk factors.
下肢运动神经病变是截石位手术患者公认的潜在并发症。然而，这种认识大多基于轶事报道，该并发症的发生率及危险因素尚未见报道。
我们回顾性分析了1957年至1991年在明尼苏达州罗切斯特市梅奥诊所接受过56种传统截石位手术中1种手术的198,461例连续患者的围手术期病程。扫描接受截石位手术患者的医学诊断，查找与神经病变相关的26种诊断。下肢持续性神经病变定义为运动功能缺损持续至少3个月。在一项1:3病例对照研究中，通过将确诊的神经病变病例与对照进行比较，分析与持续性神经病变轶事相关的危险因素。
截石位手术后发现55例持续性神经病变，发生率为每3608例中有1例。下肢持续性神经病变发生的多因素危险因素包括截石位时间达4小时或更长、体重指数（每平方米千克数）为20或更低以及手术前30天内有吸烟史。未发现区域麻醉技术与神经病变风险增加相关。在术后至少存活1年的53例患者中，24例（45%）因持续性足下垂或腿部无力需要假体或行走辅助。
这些数据表明，截石位手术时间延长以及患者危险因素，包括体型极瘦和术前吸烟，与截石位手术患者术后下肢神经病变的发生相关。对于有这些危险因素的患者，减少截石位时间可能特别有价值。
