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椎体强化手术中医护人员及患者的辐射暴露:49例病例的前瞻性多中心研究

Surgeon's and Patient's Radiation Exposure Through Vertebral Body Cement Augmentation Procedures: A Prospective Multicentric Study of 49 Cases.

作者信息

Lonjon Nicolas, Le Corre Marine, Le Roy Julien, Greffier Joël, Fuentes Stéphane, Tonetti Jérôme, Charles Yann Philippe, Blondel Benjamin, Kouyoumdjïan Pascal

机构信息

Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France.

Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France.

出版信息

World Neurosurg. 2016 Sep;93:371-6. doi: 10.1016/j.wneu.2016.05.070. Epub 2016 Jun 1.

Abstract

OBJECTIVE

Vertebral body cement augmentation as a treatment option for osteoporotic or traumatic fractures has become increasingly popular during the past decade. However, these surgical procedures require numerous fluoroscopic examinations, resulting in high radiation exposure for the patient and the surgical team. The aim of this study was to evaluate the level of radiation exposure of the spine surgeon and the patient during these percutaneous procedures.

METHODS

Forty-nine patients admitted for single- or 2-level vertebral compression fracture were prospectively included and treated with vertebral body cement augmentation. For each procedure, radiation dose was measured on the surgeon's whole body, lens, and extremities as well as patient irradiation. Each surgeon wore 2 thermoluminescent dosimeters to measure lens and extremities radiation exposure and 1 electronic personal dosimeter. Patient clinical and surgical data, effective dose to patient, and surgeon were analyzed.

RESULTS

Mean operative time was 31.5 ± 11.7 minutes. The average fluoroscopic time was 61.0 ± 27.1 seconds. The average whole-body radiation dose per procedure was 1.4 ± 2.1 μSv. The average equivalent dose to lens and extremities were 44 μSv and 59 μSv, respectively.

CONCLUSIONS

Values of radiation doses for surgeon and patient were lower than those reported in the previous literature. The recommended annual dose limit is set to 500 mSv for extremities and 150 mSv for lens. According to our results, the exposure dose to the eye exceeds the annual limit after 3500 procedures. However, there is increasing concern among surgeons about radiation exposure, and there is still a need for solutions as preventive measures.

摘要

目的

在过去十年中,椎体骨水泥强化术作为骨质疏松性或创伤性骨折的一种治疗选择越来越受欢迎。然而,这些手术需要进行多次荧光透视检查,导致患者和手术团队受到高辐射暴露。本研究的目的是评估脊柱外科医生和患者在这些经皮手术过程中的辐射暴露水平。

方法

前瞻性纳入49例因单节段或双节段椎体压缩骨折入院的患者,并接受椎体骨水泥强化治疗。对于每例手术,测量外科医生全身、晶状体和四肢的辐射剂量以及患者的辐射剂量。每位外科医生佩戴2个热释光剂量计以测量晶状体和四肢的辐射暴露,以及1个电子个人剂量计。分析患者的临床和手术数据、患者和外科医生的有效剂量。

结果

平均手术时间为31.5±11.7分钟。平均透视时间为61.0±27.1秒。每例手术的平均全身辐射剂量为1.4±2.1微希沃特。晶状体和四肢的平均当量剂量分别为44微希沃特和59微希沃特。

结论

外科医生和患者的辐射剂量值低于先前文献报道的值。推荐的年度剂量限值设定为四肢500毫希沃特,晶状体150毫希沃特。根据我们的结果,在进行3500例手术后,眼部的暴露剂量超过年度限值。然而,外科医生对辐射暴露的担忧日益增加,作为预防措施仍需要解决方案。

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