Kelly G A, Rowan F E, Hurson C
Department of Trauma and Orthopaedics, St. Vincents University Hospital, Dublin, Ireland.
Eur J Orthop Surg Traumatol. 2017 Jul;27(5):637-641. doi: 10.1007/s00590-017-1951-7. Epub 2017 Apr 10.
The use of fluoroscopy is of great importance for operative fixation of fractures. Previous studies have shown an increased fluoroscopy time for intramedullary nails and with junior surgeons in comparison with more experienced surgeons. We examined the impact of operation length on fluoroscopy dose, cumulative fluoroscopy time between consultant and registrar surgeons and cumulative fluoroscopy time between dynamic hip screw and intramedullary nailing. We performed a retrospective cohort study of all patients admitted to our centre over the period of 1 year. Patients who underwent dynamic hip screw (DHS) or intramedullary (IM) nailing were identified from our in-hospital hip fracture database. Intraoperative fluoroscopy images were then accessed through our hospital's medical imaging software. A total of 137 patients were identified. Fluoroscopy reports were not available for 49 patients, resulting in a final total of 88 patients. Patients whose operation lasted longer than 1 h received a statistically significant higher dose of radiation (183.83 cGYM2 vs. 368.22 cGYM2; p value 0.0002). Operations performed by a consultant resulted in less cumulative fluoroscopy time in comparison with those performed by a registrar or specialist registrar although this was not statistically significant (00:00:53 vs. 00:00:45; p vaue 0.38). Cumulative fluoroscopy time was less in dynamic hip screw compared to long intramedullary nails (00:00:39 vs. 00:01:29; p value <0.001) and short intramedullary nails (00:00:39 vs. 00:01:52; p value 0.387). Studies, which had a cumulative fluoroscopy time exceeding 50 secs, delivered a higher radiation dose (434.34cGYM2 vs. 150.51cGYM2; p value <0.001). We concluded that there is no significant impact in cumulative fluoroscopy time in operations performed by either a registrar or consultant. Dynamic hip screws have a lower fluoroscopy time in comparison with long intramedullary nails.
荧光透视检查在骨折手术固定中具有重要意义。先前的研究表明，与经验更丰富的外科医生相比，髓内钉手术的荧光透视时间增加，且初级外科医生的荧光透视时间更长。我们研究了手术时长对荧光透视剂量的影响、顾问医生与住院医生之间的累积荧光透视时间以及动力髋螺钉与髓内钉固定术之间的累积荧光透视时间。我们对本中心1年内收治的所有患者进行了一项回顾性队列研究。通过我们的院内髋部骨折数据库确定接受动力髋螺钉（DHS）或髓内（IM）钉固定术的患者。然后通过我们医院的医学影像软件获取术中荧光透视图像。共确定了137例患者。49例患者没有荧光透视报告，最终共有88例患者。手术持续时间超过1小时的患者接受的辐射剂量在统计学上显著更高（183.83 cGYM2对368.22 cGYM2；p值0.0002）。与住院医生或专科住院医生进行的手术相比，顾问医生进行的手术累积荧光透视时间更少，尽管这在统计学上不显著（00:00:53对00:00:45；p值0.38）。与长髓内钉相比，动力髋螺钉的累积荧光透视时间更少（00:00:39对00:01:29；p值<0.001），与短髓内钉相比也是如此（00:00:39对00:01:52；p值0.387）。累积荧光透视时间超过50秒的研究辐射剂量更高（434.34cGYM2对150.51cGYM2；p值<0.001）。我们得出结论，住院医生或顾问医生进行的手术在累积荧光透视时间方面没有显著影响。与长髓内钉相比，动力髋螺钉的荧光透视时间更短。
