Fransen Patrick
Department of Neurosurgery, Clinique du Parc Léopold CHIREC, Brussels, Belgium.
Acta Orthop Belg. 2011 Jun;77(3):386-9.
The widespread use of minimally invasive and other spinal procedures raises concern about the peroperative radiation exposure to surgeon and patient. The authors noted the fluoroscopy time and the radiation dose, as read from the image amplifier, in 95 spinal procedures. The results of this prospective study varied widely between different operations. Percutaneous surgery was associated with more exposure than open surgery. For instance, the average radiation dose per pedicle screw was 3.2 times higher with percutaneous insertion than with an open approach. Therefore, efforts to reduce fluoroscopy time and radiation exposure should be made when using minimally invasive percutaneous surgical techniques. Preventive measures for the surgeon, such as lead aprons and gloves, thyroid shields, radioprotective glasses and staying away from the beam are recommended. Still from the surgeon's view-point, source inferior positioning of the image amplifier is indicated for the AP view, as well as monitoring of the radiation exposure. Finally, the difference in fluoroscopy time and radiation exposure between surgeons for the same procedure stresses the fact that peroperative radiation may be reduced by simple awareness and by training.
微创及其他脊柱手术的广泛应用引发了人们对外科医生和患者术中辐射暴露的担忧。作者记录了95例脊柱手术中从影像增强器读取的透视时间和辐射剂量。这项前瞻性研究的结果在不同手术之间差异很大。与开放手术相比，经皮手术的辐射暴露更多。例如，经皮植入每枚椎弓根螺钉的平均辐射剂量比开放手术高3.2倍。因此，在使用微创经皮手术技术时，应努力减少透视时间和辐射暴露。建议为外科医生采取预防措施，如铅围裙和手套、甲状腺防护装置、辐射防护眼镜以及远离射线束。从外科医生的角度来看，对于前后位（AP）视图，影像增强器应采用源-影像增强器-患者（SIIP）位，同时监测辐射暴露。最后，同一手术中不同外科医生之间透视时间和辐射暴露的差异强调了一个事实，即通过简单的意识和培训可以减少术中辐射。
