基于三维透视导航辅助三维透视控制的椎弓根螺钉器械的时间需求和辐射剂量。
Time Demand and Radiation Dose in 3D-Fluoroscopy-based Navigation-assisted 3D-Fluoroscopy-controlled Pedicle Screw Instrumentations.
机构信息
Department of Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Schwarzach, Germany.
出版信息
Spine (Phila Pa 1976). 2018 May 1;43(9):E512-E519. doi: 10.1097/BRS.0000000000002422.
STUDY DESIGN
Prospective single-center cohort study to record additional time requirements and radiation dose in navigation-assisted O-arm-controlled pedicle screw (PS) instrumentations.
OBJECTIVE
The aim of this study was to evaluate amount of extra-time and radiation dose for navigation-assisted PS instrumentations of the thoracolumbosacral spine using O-arm 3D-real-time-navigation (O3DN) compared to non-navigated spinal procedures (NNSPs) with a single C-arm and postoperative computed tomography (CT) scan for controlling PS positions.
SUMMARY OF BACKGROUND DATA
3D-navigation is reported to enhance PS insertion accuracy. But time-consuming navigational steps and considerable additional radiation doses seem to limit this modern technique's attraction. A detailed analysis of additional time demand and extra-radiation dose in 3D-navigated spine surgery is not provided in literature, yet.
METHODS
From February 2011 through July 2015, 306 consecutive posterior instrumentations were performed in vertebral levels T10-S1 using O3DN for PS insertion. The duration of procedure-specific navigational steps of the overall collective (I) and the last cohort of 50 consecutive O3DN-surgeries (II) was compared to the average duration of analogous surgical steps in 100 consecutive NNSP using a single C-arm. 3D-radiation dose (dose-length-product, DLP) of navigational and postinstrumentation O-arm scans in group I and II was compared to the average DLP of 100 diagnostic lumbar CT scans.
RESULTS
The average presurgical time from patient positioning on the operating table to skin incision was 46.2 ± 10.1 minutes (O3DN, I) and 40.6 ± 9.8 minutes (O3DN, II) versus 30.6 ± 8.3 minutes (NNSP) (P < 0.001, each). Intraoperative interruptions for scanning and data processing took 3.0 ± 0.6 minutes. DLPs averaged 865.1 ± 360.8 mGycm (O3DN, I) and 562.1 ± 352.6 mGycm (O3DN, II) compared to 575.5 ± 316.5 mGycm in diagnostic lumbar CT scans (P < 0.001 (I), P ≈ 0.81 [II]).
CONCLUSION
After procedural experience, navigated surgeries can be performed with an additional time demand of 13.0 minutes compared to NNSP, and with a total DLP below that of a diagnostic lumbar CT scan (P ≈ 0.81).
LEVEL OF EVIDENCE
研究设计
前瞻性单中心队列研究，记录导航辅助 O 臂控制的椎弓根螺钉（PS）器械置入中额外的时间需求和辐射剂量。
目的
本研究旨在评估使用 O 臂 3D 实时导航（O3DN）进行胸腰椎骶骨 PS 器械导航辅助与仅使用单 C 臂进行非导航脊柱手术（NNSP）以及术后 CT 扫描控制 PS 位置相比，额外时间和辐射剂量。
背景资料摘要
3D 导航被报道可提高 PS 插入的准确性。但耗时的导航步骤和相当大的额外辐射剂量似乎限制了这项现代技术的吸引力。3D 导航脊柱手术中额外时间需求和额外辐射剂量的详细分析尚未在文献中提供。
方法
从 2011 年 2 月至 2015 年 7 月，使用 O3DN 对 T10-S1 进行了 306 例连续后路器械置入。比较了整个队列（I）和最后 50 例连续 O3DN 手术（II）的特定手术导航步骤的持续时间与 100 例连续使用单 C 臂进行的 NNSP 中类似手术步骤的平均持续时间。比较了队列 I 和 II 中导航和术后 O 臂扫描的 3D 辐射剂量（剂量长度乘积，DLP）与 100 例诊断性腰椎 CT 扫描的平均 DLP。
结果
从患者在手术台上的体位到皮肤切口的术前平均时间为 46.2±10.1 分钟（O3DN，I）和 40.6±9.8 分钟（O3DN，II），而 NNSP 为 30.6±8.3 分钟（P<0.001，各）。术中扫描和数据处理中断时间为 3.0±0.6 分钟。DLP 平均值为 865.1±360.8 mGycm（O3DN，I）和 562.1±352.6 mGycm（O3DN，II），而诊断性腰椎 CT 扫描为 575.5±316.5 mGycm（P<0.001（I），P≈0.81[II]）。
结论
与 NNSP 相比，经过手术经验，导航手术可额外增加 13.0 分钟的手术时间，总 DLP 低于诊断性腰椎 CT 扫描（P≈0.81）。
证据水平
4 级
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