Department of Orthopedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
Spine (Phila Pa 1976). 2018 Dec 1;43(23):E1398-E1402. doi: 10.1097/BRS.0000000000002718.
Prospective case series.
To analyze the radiation exposure to the surgeons and patients in fluoroscopic-guided segmental pedicle screw placement for pediatric scoliosis.
Fluoroscopic-guided pedicle screw placement is a safer technique for pedicle screw placement in spinal deformity. However, radiation exposure is a concern, particularly for spine surgeons due to the requirement of multiple pedicle screws in spinal deformity surgery.
We measured radiation dose to the surgeons and pediatric patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2) from March 2016 to December 2017. Surgery was performed using fluoroscopic-guided segmental pedicle screw placement. The dosimeters were placed at the forehead, inside and outside thyroid shield, both hands, back, and suprapubic under lead apron for each surgeon; and at the thyroid and gonads for patients.
Thirty patients were included in the study. The mean numbers of pedicle screws per case were 23.2 ± 3.4. The mean dose (mrem) per case for the two surgeons S1 and S2 was 0.07 and 0.47 at forehead, 0.07 and 0.37 at outside thyroid shield, 0.00 and 0.30 at inside thyroid shield, 16.87 and 13.73 at right hand, 6.07 and 11.37 at left hand, 0.50 and 0.00 at back, and 0.00 and 0.00 at suprapubic under lead apron, respectively. The mean dose (mrem) per case for the male and female patient was 3.67 and 14.71 for thyroid and 3.83 and 3.17 for gonads, respectively.
The results of this study demonstrated that radiation exposure to the spine surgeons and patients is low using fluoroscopic-guided segmental pedicle screw technique for pediatric scoliosis surgery. Both hands of the surgeons received much higher doses compared to other body areas and, and thus radiation-reducing gloves and careful attention to surgeon's hands need to be considered for this procedure.
前瞻性病例系列研究。
分析透视引导下儿童脊柱侧凸节段椎弓根螺钉置钉时术者和患者的放射暴露情况。
透视引导下椎弓根螺钉置钉是脊柱畸形椎弓根螺钉置钉更安全的技术。然而，放射暴露是一个关注点，特别是对于脊柱外科医生，因为脊柱畸形手术需要多个椎弓根螺钉。
我们在 2016 年 3 月至 2017 年 12 月期间，由两名外科医生（S1 和 S2）团队测量了接受脊柱侧凸手术的外科医生和儿科患者的放射剂量。手术采用透视引导下节段性椎弓根螺钉置入。术者的每个测位器放置在前额、甲状腺外罩内和外、双手、背部和耻骨下铅围裙下；患者的测位器放置在甲状腺和性腺上。
本研究共纳入 30 例患者。每位患者的平均椎弓根螺钉数量为 23.2±3.4 个。两名外科医生 S1 和 S2 的每个病例的平均剂量（mrem）分别为 0.07 和 0.47 在前额，0.07 和 0.37 在甲状腺外罩外，0.00 和 0.30 在甲状腺内罩内，16.87 和 13.73 在右手，6.07 和 11.37 在左手，0.50 和 0.00 在背部，0.00 和 0.00 在耻骨下铅围裙下。男性和女性患者的甲状腺平均剂量（mrem）分别为 3.67 和 14.71，性腺分别为 3.83 和 3.17。
本研究结果表明，透视引导下节段性椎弓根螺钉技术用于儿童脊柱侧凸手术，术者和患者的放射暴露量较低。与其他身体部位相比，外科医生的双手接受了更高的剂量，因此需要考虑使用防辐射手套，并在手术过程中小心注意术者的双手。
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