沙滩椅位和侧卧位在肩关节镜手术中的应用  

Application of beach chair position and lateral decubitus position in shoulder arthroscopy

作　　者：黄海峰[1] 田家亮[2] 孙立[2] 杨先腾[1] 申雨坤 鄢志辉[2] 李姗姗[3] 田晓滨[2] 谢泉[4] 

机构地区：[1]贵州大学医学院,贵阳550025 [2]贵州省人民医院骨科,贵阳550002 [3]贵州省人民医院麻醉科,贵阳550002 [4]贵州大学大数据与信息工程学院,贵阳550025

出　　处：《中华骨科杂志》2017年第12期756-762,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金地区基金（81560356）

摘　　要：应用关节镜技术微创治疗肩关节疾病已经成为一种常规的治疗手段,并在世界范围内得到广泛开展.与传统开放手术相比,只需要在肩关节局部建立几个通道即可以通过关节镜技术直视下完成对肩峰下结构及盂肱关节内部病变的诊断和治疗.肩关节镜手术具有操作技术简便,患者经济负担小,组织创伤小,恢复快,且疾病诊断准确率高等优点.目前肩关节镜手术中的体位主要有两种选择：即沙滩椅位和侧卧位.手术体位的选择与术中的操作情况、并发症的发生风险、手术疗效及体位的设置成本密切相关.肩关节镜手术两种体位均有各自的优、缺点.采用沙滩椅体位,术者具有更好的解剖学操作体验,如有需要可以随时转为开放手术,患肢无需持续牵引,避免因牵引导致的上肢神经、血管损伤;但可能会增加患者脑缺血事件的发生率,也存在枕小神经、耳大神经及股外侧皮神经等神经损伤的可能,并在理论上会增加患者发生空气栓塞的风险,在体位设置成本上也高于侧卧位.而侧卧位因患者前臂的持续牵引,术者可获得更加宽广的操作空间,脑缺血事件的发生十分罕见,且用于治疗肩关节前方不稳定患者术后具有更低的复发率,体位设置成本也较沙滩椅位明显降低;但侧卧位的劣势也显而易见,前臂的持续牵引增加了臂丛神经等神经、血管损伤的可能,同时持续牵引力也是血栓形成的危险因素等.关于肩关节镜手术中最佳体位的选择,因沙滩椅位和侧卧位有其各自的优、缺点,临床医生对肩关节镜手术中体位的选择多基于自己的经验和习惯.The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine,and it has been widely carried out around the world.Compared with the traditional open surgery,it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision,of course,including local collection of pathological specimens.Shoulder arthroscopic surgery has the advantages of simple operation technique,small economic burden of patients,small tissue trauma,quick recovery and high accuracy of disease diagnosis.At present,there are two main options for shoulder arthroscopy：the beach chair position （BCP） and the lateral decubitus position （LDP）.The choice of surgical position for surgeons is closely related to the intraoperative operation,the risk of complications,the efficacy of surgery,and the cost of setting the posture.Shoulder arthroscopy of these two positions have their own advantages and disadvantages：in the BCP,the surgeon gets a better anatomical operation experience,if necessary,can be converted into open surgery at any time.Without continuous traction,upper limb nerve and vascular damage caused by traction can be avoid.But the incidence of cerebral ischemic events in patients may increase in the BCP.There is also possibility of the nerve damage of the pillow small nerve,great auricular nerve,lateral femoral cutaneous nerve and other nerves.In theory the risk of air embolism in the patients will increase in the BCP,and the cost of setting the position is also higher than the LDP.While in the LDP due to the patient＆#39;s forearm continuous traction,the surgeon can get a more extensive operating space,and the occurrence of cerebral ischemic events is very rare.In the treatment of anterior shoulder instability after shoulder arthroscopic surgery,there is a lower recurrence rate in the LDP.The cost of s

关 键 词：肩关节镜手术 沙滩椅体位 侧卧位 手术中 应用 传统开放手术 肩关节前方不稳 手术体位 

分 类 号：R687.4[医药卫生—骨科学]