Matityahu Amir, Duffy Ryan K, Goldhahn Sabine, Joeris Alexander, Richter Peter H, Gebhard Florian
San Francisco General Hospital-Orthopaedic Trauma Institute, San Francisco, CA, USA.
San Francisco General Hospital-Orthopaedic Trauma Institute, San Francisco, CA, USA.
Injury. 2017 Aug;48(8):1727-1734. doi: 10.1016/j.injury.2017.04.041. Epub 2017 Apr 21.
Modern techniques in orthopaedic surgery using minimally invasive procedures, and increased use of fluoroscopic imaging present a potential increased risk to surgeons due to ionizing radiation exposure. This article is a systematic review of recent literature on radiation exposure of orthopaedic surgeons.
Pubmed and Cochrane searches were performed on intraoperative radiation exposure covering English and German articles published between 1.1.2000 and 11.8.2014. Inclusion criteria were clinical studies and systematic literature reviews focusing on radiation exposure of orthopaedic surgeons during surgical procedures of the musculoskeletal system reporting either effective dose (whole body) or equivalent dose at the organ level. All included articles were reviewed with focus on the surgical specialty, the procedure type, the imaging system used, the radiation measurement method, the fluoroscopy time, the radiation exposure, the use of radiation protection, and any references to specific safety guidelines.
Thirty-four eligible publications were identified. However, the lack of well-designed studies focusing on radiation exposure of surgeons prevents pooling of data. Highest exposure and subsequent equivalent doses were reported from spinal surgery (up to 4.8mSv of equivalent dose to the hand) and intramedullary nailing (up to 0.142mSV of equivalent dose to the thyroid). Radiation exposure was reduced by 96.9% and 94.2% when wearing a thyroid collar and a lead apron.
With the increasing use of intraoperative imaging, there is a growing need for radiation awareness by the operating surgeon. Strict adherence to radiation protection should be enforced to protect in-training surgeons. Strategies to reduce exposure include C-arm position, distance, protective wear, and new imaging technologies. Radiation exposure is harmful and action should be taken to minimize exposure.
现代骨科手术采用微创技术，且越来越多地使用荧光透视成像，这因电离辐射暴露给外科医生带来了潜在的更高风险。本文是对近期有关骨科医生辐射暴露的文献的系统综述。
在PubMed和Cochrane数据库中进行检索，查找2000年1月1日至2014年8月11日期间发表的关于术中辐射暴露的英文和德文文章。纳入标准为临床研究和系统文献综述，重点关注骨科医生在肌肉骨骼系统手术过程中的辐射暴露情况，报告有效剂量（全身）或器官水平的当量剂量。对所有纳入文章进行综述，重点关注手术专科、手术类型、使用的成像系统、辐射测量方法、透视时间、辐射暴露、辐射防护的使用以及对特定安全指南的任何提及。
共识别出34篇符合条件的出版物。然而，缺乏针对外科医生辐射暴露的精心设计的研究，无法汇总数据。脊柱手术（手部当量剂量高达4.8mSv）和髓内钉固定术（甲状腺当量剂量高达0.142mSv）报告的辐射暴露和随后的当量剂量最高。佩戴甲状腺颈圈和铅围裙时，辐射暴露分别降低了96.9%和94.2%。
随着术中成像的使用增加，主刀医生对辐射的认识需求也日益增长。应强制严格遵守辐射防护措施，以保护实习外科医生。减少暴露的策略包括C型臂位置、距离、防护装备和新的成像技术。辐射暴露有害，应采取行动将暴露降至最低。
