Kabariti Rakan, Green Natalie, Turner Robert
Trauma & Orthopaedics, Princess Royal Hospital NHS Trust, Telford, UK.
Bone Jt Open. 2021 Sep;2(9):752-756. doi: 10.1302/2633-1462.29.BJO-2021-0070.R1.
During the COVID-19 pandemic, drilling has been classified as an aerosol-generating procedure. However, there is limited evidence on the effects of bone drilling on splatter generation. Our aim was to quantify the effect of drilling on splatter generation within the orthopaedic operative setting.
This study was performed using a Stryker System 7 dual rotating drill at full speed. Two fluid mediums (Videne (Solution 1) and Fluorescein (Solution 2)) were used to simulate drill splatter conditions. Drilling occurred at saw bone level (0 cm) and at different heights (20 cm, 50 cm, and 100 cm) above the target to simulate the surgeon 'working arm length', with and without using a drill guide. The furthest droplets were marked and the droplet displacement was measured in cm. A surgical microscope was used to detect microscopic droplets.
Bone drilling produced 5 cm and 7 cm droplet displacement using Solutions 1 and 2, respectively. Drilling at 100 cm above the target produced the greatest splatter generation with a 95 cm macroscopic droplet displacement using Solution 2. Microscopic droplet generation was noticed at further distances than what can be macroscopically seen using Solution 1 (98 cm). Using the drill guide, there was negligible drill splatter generation.
Our study has shown lower than anticipated drill splatter generation. The use of a drill guide acted as a protective measure and significantly reduced drill splatter. We therefore recommend using a drill guide at all times to reduce the risk of viral transmission in the operative setting. Cite this article: 2021;2(9):752-756.
在新冠疫情期间，钻孔操作被归类为产生气溶胶的操作。然而，关于骨钻孔对飞沫产生影响的证据有限。我们的目的是量化在骨科手术环境中钻孔对飞沫产生的影响。
本研究使用史赛克7系统双旋转钻全速进行。使用两种流体介质（聚维酮碘溶液（溶液1）和荧光素（溶液2））来模拟钻孔飞沫情况。在锯骨水平（0厘米）以及在目标上方不同高度（20厘米、50厘米和100厘米）进行钻孔，以模拟外科医生的“工作臂长度”，有或没有使用钻孔导向器。标记最远的飞沫，并以厘米为单位测量飞沫位移。使用手术显微镜检测微观飞沫。
使用溶液1和溶液2进行骨钻孔时，飞沫位移分别为5厘米和7厘米。在目标上方100厘米处钻孔产生的飞沫最多，使用溶液2时宏观飞沫位移为95厘米。使用溶液1时，微观飞沫产生的距离比宏观可见的距离更远（98厘米）。使用钻孔导向器时，钻孔飞沫产生可忽略不计。
我们的研究表明钻孔飞沫产生低于预期。使用钻孔导向器起到了保护作用，并显著减少了钻孔飞沫。因此，我们建议始终使用钻孔导向器，以降低手术环境中病毒传播的风险。引用本文：2021；2（9）：752 - 756。
