后路腰椎内固定手术中外科医生和患者所受的辐射暴露：导航技术与非导航徒手技术的前瞻性随机比较
Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques.
作者信息
Villard Jimmy, Ryang Yu-Mi, Demetriades Andreas K, Reinke Andreas, Behr Michael, Preuss Alexander, Meyer Bernhard, Ringel Florian
机构信息
From the Department of Neurosurgery, Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany.
出版信息
Spine (Phila Pa 1976). 2014 Jun 1;39(13):1004-9. doi: 10.1097/BRS.0000000000000351.
STUDY DESIGN
A prospective randomized study.
OBJECTIVE
To compare occupational radiation exposure to the surgeon, as well as the patient, during posterior lumbar spine instrumentation in 10 navigated cases (navigated) versus 11 cases using the freehand technique (non-navigated).
SUMMARY OF BACKGROUND DATA
The use of navigation increases the accuracy of posterior lumbar instrumentation.A further speculated benefit of navigation is the reduction of radiation exposure of the surgeon. However, this has so far not been evaluated in such comparative manner.
METHODS
Radiation exposure to the surgeon was measured by digital dosimeters placed at the level of the eye, chest, and dominant forearm. Radiation exposure was measured from the time of positioning of the patient to the end of the procedure both for navigated (intraoperative 3-dimensional [3D] fluoroscopy-based) and non-navigated (2-dimensional fluoroscopy-guided) freehand posterior lumbar spine instrumentations. A 3D fluoroscopic scan was routinely performed at the end of the procedure for all patients.
RESULTS
Patients were distributed evenly in the 2 groups in terms of sex, age, body mass index, and the number of operated levels. The accumulated radiation dose for the surgeon was significantly higher in the non-navigated group; up to 9.96 times. The radiation dose for the patient was higher with the freehand technique, 1884.8 cGy·cm (non-navigated) versus 887 cGy·cm (navigated), without reaching a statistically significant level.
CONCLUSION
Radiation exposure to the surgeon during pedicle screw placement with the freehand technique is up to 9.96 times greater than with the use of navigation. In the latter group, the only radiation exposure comes from the preoperative-level control and positioning of the 3D C-arm before 3D fluoroscopic acquisition. Furthermore, neuronavigation also reduces the cumulative dose for the patient.
LEVEL OF EVIDENCE
研究设计
前瞻性随机研究。
目的
比较10例使用导航技术（导航组）与11例使用徒手技术（非导航组）进行腰椎后路内固定手术时，外科医生以及患者所受到的职业辐射暴露情况。
背景资料总结
导航技术的应用提高了腰椎后路内固定的准确性。导航技术的另一个推测益处是减少外科医生的辐射暴露。然而，迄今为止尚未以这种比较方式进行评估。
方法
通过放置在眼睛、胸部和优势前臂水平的数字剂量计测量外科医生的辐射暴露。在患者定位至手术结束期间，测量导航组（基于术中三维[3D]荧光透视）和非导航组（二维荧光透视引导）徒手腰椎后路内固定手术的辐射暴露。所有患者在手术结束时常规进行一次3D荧光透视扫描。
结果
两组患者在性别、年龄、体重指数和手术节段数量方面分布均匀。非导航组外科医生的累积辐射剂量显著更高，高达9.96倍。徒手技术组患者的辐射剂量更高，分别为1884.8 cGy·cm（非导航组）和887 cGy·cm（导航组），但未达到统计学显著水平。
结论
徒手技术进行椎弓根螺钉置入时外科医生所受到的辐射暴露比使用导航技术时高出9.96倍。在导航组中，唯一的辐射暴露来自术前水平控制和3D荧光透视采集前3D C形臂的定位。此外，神经导航还降低了患者的累积剂量。
证据级别
2级。
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