Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, KY.
Department of Orthopaedics, Harborview Medical Center, Harborview Medical Center, University of Washington, Seattle, WA.
J Orthop Trauma. 2019 Dec;33(12):e471-e474. doi: 10.1097/BOT.0000000000001592.
Fluoroscopy is used in many orthopaedic procedures. The C-Arm drape is known to be easily contaminated during orthogonal imaging. However, it is unknown if one area of the operative field is more prone to contamination than another. The purpose of this study was to determine if secondary transfer of contaminate from the undraped portion of the C-Arm occurs.
A C-Arm was utilized with standardized draping in a simulated operating room. We used a simulated contaminant: a fluorescent powder that phosphoresces under ultraviolet light. The powder was placed over nonsterile portions. A darkened room with a black light, and a camera was used. C-Arm movements were simulated by cycling through lateral to Anteroposterior imaging. Images were taken before (control) and after cycles of orthogonal imaging. The change in light intensity was quantified at each time point over each area as a percentage of change.
Contamination of the surgical field was observed in all areas after 15 cycles, with the area adjacent to the C-Arm being most pronounced. A linear increase in intensity with increased cycles was observed (R = 0.297; P = 0.036), with the mean increase in intensity of 5% after 15 cycles (95% confidence interval, 1.97-7.86). The remaining areas (closest to surgeon and middle) showed an increase as well but were not significant (P > 0.05).
Secondary contamination of the surgical field from the C-Arm occurs. The area most prone to contamination is the area immediately adjacent to the fluoroscopy unit, usually opposite the surgeon.
透视在许多矫形手术中都有应用。已知 C 型臂的非覆盖区域在正交成像时很容易受到污染。然而，目前尚不清楚手术区域的一个部位是否比另一个部位更容易受到污染。本研究旨在确定 C 型臂未覆盖部分的污染物是否会发生二次转移。
在模拟手术室中使用 C 型臂并进行标准化覆盖。我们使用模拟污染物：在紫外线照射下发出磷光的荧光粉。将粉末放置在非无菌部位。使用暗室中的黑光和相机。通过在侧位到前后位成像之间循环来模拟 C 型臂运动。在每次循环前后拍摄图像（对照）。在每个时间点，通过每个区域的光强度变化来量化变化百分比。
在经过 15 次循环后，所有区域都观察到手术区域的污染，靠近 C 型臂的区域最为明显。观察到强度随循环次数的线性增加（R = 0.297；P = 0.036），在 15 次循环后强度平均增加 5%（95%置信区间，1.97-7.86）。其余区域（最靠近外科医生和中间区域）也有所增加，但无统计学意义（P > 0.05）。
C 型臂会对手术区域造成二次污染。最容易受到污染的区域是紧邻透视设备的区域，通常与外科医生相对。
