Roukis Thomas S, Iceman Kelli, Elliott Andrew D
Attending Staff, Orthopaedic Center, Gundersen Health System, La Crosse, WI.
Rosalind Franklin University of Medicine and Science, North Chicago, IL.
J Foot Ankle Surg. 2016 Jul-Aug;55(4):732-7. doi: 10.1053/j.jfas.2016.01.039.
Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.
初次全踝关节置换植入手术需要术中使用C型臂影像增强器。这些手术与显著的辐射暴露有关；然而，翻修全踝关节置换手术期间的辐射暴露情况仍不清楚。因此，我们试图评估翻修全踝关节置换手术期间的辐射暴露情况。我们对一个前瞻性数据库中41例患者的数据进行了回顾性分析：19例从Agility(™)翻修为Agility(™)；4例从Agility(™)翻修为定制Agility(™)；9例从Agility(™)翻修为INBONE(®) II；5例从Agility(™)翻修为Salto Talaris(®) XT；2例从斯堪的纳维亚全踝关节置换假体翻修为Salto Talaris(®) XT；以及2例从INBONE(®) I翻修为INBONE(®) II的翻修全踝关节置换手术。我们确定了两大类：部分翻修（从Agility(™)翻修为Agility(™)、从Agility(™)翻修为定制Agility(™)、从INBONE(®) I翻修为INBONE(®) II）和完全转换（从Agility(™)翻修为INBONE(®) II、从Agility(™)翻修为Salto Talaris(®) XT、从斯堪的纳维亚全踝关节置换假体翻修为Salto Talaris(®) XT）。每例患者的平均辐射暴露量为3.49±2.21毫戈瑞，具有显著性。完全转换，特别是从Agility(™)翻修为INBONE(®) II，显示出最大的辐射暴露量和C型臂使用时间。翻修植入物的选择和翻修类型（完全或部分）直接影响辐射暴露。因此，需要较少辐射暴露的翻修系统更可取。外科医生应努力将术中并发症降至最低，并将额外手术限制在必要的范围内，因为这两者都会导致额外的辐射暴露。
