Traumatology and Orthopedics Department, Saint-Roch Hospital, Nice University Hospital Center, 5, rue Pierre-Dévoluy, 06000 Nice, France.
Orthop Traumatol Surg Res. 2011 Oct;97(6):662-7. doi: 10.1016/j.otsr.2011.03.024. Epub 2011 Sep 22.
Repeated use of X-rays in orthopedic surgery poses the problem of irradiation of patient and caregivers. Seven common minimally invasive bone trauma surgical procedures requiring image intensifier use were investigated: percutaneous K-wire fixation of the wrist, minimally invasive fixation plating of the wrist, percutaneous intramedullary nailing of the tibia and of the femur, short and long trochanteric nail fixation of trochanteric and sub-trochanteric fracture, and percutaneous fixation of thoracolumbar fracture. The study analyzed three parameters: dose area product (DAP), radiation duration, and skin entrance dose (SED). Data were collected from 15 successive implementations of each procedure. The aim of the study was to establish a database for this kind of bone trauma surgery and a hierarchy of the X-ray doses delivered. Percutaneous spinal osteosynthesis involved the highest dose, followed in decreasing order by long trochanteric nailing, femoral nailing, short trochanteric nailing, tibial nailing, wrist K-wire fixation and frontal wrist plate osteosynthesis. One short trochanteric nail procedure delivered the same DAP as 13 wrist K-wire fixation procedures, and one spinal osteosynthesis was equivalent to 13 short trochanteric nail or 174 wrist K-wire procedures. The anatomic area X-rayed appeared to be the main radiation dose factor. A database was established, but actual patient and staff radiation levels remained unknown.
在骨科手术中反复使用 X 射线会给患者和护理人员带来辐射问题。研究了七种常见的微创骨创伤手术,这些手术都需要使用影像增强器:腕部经皮 K 线固定术、腕部微创接骨板固定术、胫骨和股骨经皮髓内钉固定术、转子间和转子下骨折的短和长转子钉钉固定术以及胸腰椎骨折的经皮固定术。该研究分析了三个参数:剂量面积乘积(DAP)、辐射持续时间和皮肤入口剂量(SED)。从每个手术的 15 次连续实施中收集数据。研究的目的是为这种骨创伤手术建立一个数据库,并确定 X 射线剂量的等级。经皮脊柱骨合成术的剂量最高,其次是长转子钉钉固定术、股骨钉钉固定术、短转子钉钉固定术、胫骨钉钉固定术、腕部 K 线固定术和腕部前路接骨板固定术。一次短转子钉钉固定术的 DAP 与 13 次腕部 K 线固定术相同,一次脊柱骨合成术相当于 13 次短转子钉钉固定术或 174 次腕部 K 线固定术。被照射的解剖区域似乎是主要的辐射剂量因素。虽然已经建立了一个数据库,但实际的患者和工作人员的辐射水平仍然未知。
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