Marco Rex A W, Curry Michael C, Mujezinovic Faruk, Linton Judith
Shriners Hospitals for Children-Houston, 6977 Main St., Houston, TX, 77030, USA.
Houston Methodist Orthopedics and Sports Medicine, 6445 Main St, Outpatient Center, Suite 2500, Houston, TX, 77030, USA.
Spine Deform. 2020 Jun;8(3):405-411. doi: 10.1007/s43390-020-00086-5. Epub 2020 Feb 24.
Quality improvement evaluation with retrospective analysis.
To compare a technique to place pedicle screws (PS) using a novel detachable pedicle marker and probe (DPMP) and pulsed fluoroscopy (PF) vs. conventional technique utilizing PF with standard instruments (SI) and O-arm. Spinal fusion with pedicle screw instrumentation (PSI) is the mainstay in treatment of spinal deformities. Reports suggest that CT navigated (O-arm) PS placement is more accurate than fluoroscopy. However, these studies have not considered the increased radiation exposure associated with CT.
Thirty-six patients with spinal deformity had PSI using PF and DPMPs. Accuracy of PS placement and radiation data from 14 dosimeters placed on the patient and around the operating room was analyzed. Results were compared to published data.
Mean fluoroscopic time was 13.4 s (range 6.0-32.4), and the mean cumulative dose was 3.1 mGy (range 0.2-16.4). Median estimated effective dose to the patient was 0.22 mSv (range 0.0-0.7). The effective dose of radiation was reduced by 80% (0.22 mSv vs. 1.11 mSv) compared to low-dose O-arm. The surgical team did not receive any detectable radiation. The seconds of PF used to assist and confirm placement of PSs was reduced to 1.2 s/level compared to previous reports of 4.49 s/level using SIs. DPMPs reduced fluoroscopy to 0.84 s/PS compared to 7.36 s/PS using SIs to assist and confirm PS placement. PSs were accurately placed in 561 of 576 (97.4%), which is comparable to O-arm and fluoroscopy with SIs.
PS placement using PF and DPMPs to assist and confirm PS placement lowers radiation exposure to the patient and surgical team without compromising accuracy compared to O-arm and fluoroscopy with SIs.
Therapeutic, Level IV (Retrospective case series, historical control).
采用回顾性分析的质量改进评估。
比较一种使用新型可拆卸椎弓根标记物和探针（DPMP）及脉冲透视（PF）置入椎弓根螺钉（PS）的技术与利用PF及标准器械（SI）和O型臂的传统技术。椎弓根螺钉内固定术（PSI）是治疗脊柱畸形的主要方法。报告表明，CT导航（O型臂）下的PS置入比透视更准确。然而，这些研究未考虑与CT相关的辐射暴露增加问题。
36例脊柱畸形患者接受了使用PF和DPMPs的PSI。分析了14个置于患者身上及手术室周围的剂量仪所测得的PS置入准确性和辐射数据。将结果与已发表的数据进行比较。
平均透视时间为13.4秒（范围6.0 - 32.4秒），平均累积剂量为3.1毫戈瑞（范围0.2 - 16.4毫戈瑞）。患者的估计中位有效剂量为0.22毫希沃特（范围0.0 - 0.7毫希沃特）。与低剂量O型臂相比，辐射有效剂量降低了80%（0.22毫希沃特对1.11毫希沃特）。手术团队未受到任何可检测到的辐射。用于辅助和确认PS置入的PF时间与之前使用SI时4.49秒/节段的报告相比，减少至1.2秒/节段。与使用SI辅助和确认PS置入时7.36秒/枚PS相比，DPMPs将透视时间减少至0.84秒/枚PS。576枚PS中有561枚（97.4%）准确置入，这与O型臂及使用SI的透视相当。
与O型臂及使用SI的透视相比，使用PF和DPMPs辅助和确认PS置入可降低患者及手术团队的辐射暴露，且不影响准确性。
治疗性，IV级（回顾性病例系列，历史对照）。
