Chitnavis J P, Karthikesalingam A, Macdonald A, Brown C
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK.
Ann R Coll Surg Engl. 2010 May;92(4):330-4. doi: 10.1308/003588410X12628812459814.
Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients.
Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient.
The median age of 58 patients included in data analysis was 28 years (range, 14-52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 +/- 0.0029 Gy. The mean ED was 0.001 +/- 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%.
Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure.
精确的隧道定位对于前交叉韧带（ACL）重建的成功至关重要。术中使用透视已被证明可提高隧道放置的准确性。尽管辐射暴露是一个问题，但我们缺乏关于使用标准C型臂进行透视辅助ACL重建的患者辐射风险的信息。我们研究的目的是确定患者接受的平均辐射剂量。
记录了2007年4月1日至2008年9月30日期间连续58例接受术中透视辅助ACL重建患者18个月的辐射剂量。使用剂量面积乘积（DAP）值计算每位患者的入射皮肤剂量（ESD），这是潜在皮肤损伤的指标，以及有效剂量（ED），这是长期癌症风险的指标。
纳入数据分析的58例患者的中位年龄为28岁（范围14 - 52岁），其中44例为男性（76%）。术中透视期间的平均ESD为0.0015 +/- 0.0029 Gy。平均ED为0.001 +/- 0.002 mSv。没有结果超过皮肤损伤的2 Gy阈值，并且术中透视导致新发癌症的终身风险小于0.0001%。
透视辅助ACL重建期间给予的辐射剂量是安全的，并不构成该手术的禁忌证。
