Rohe Sebastian, Strube Patrick, Hölzl Alexander, Böhle Sabrina, Zippelius Timo, Lindemann Chris
Orthopedic Department Waldkliniken Eisenberg, Professorship of the University Hospital Jena, 07607 Eisenberg, Germany.
Department of Orthopedic Surgery, University of Ulm, 89081 Ulm, Germany.
J Pers Med. 2022 May 1;12(5):736. doi: 10.3390/jpm12050736.
This study investigates the advantages and disadvantages of cone-beam-based navigated standardized posterior lumbar interbody fusion surgery (PLIF), regarding the radiation exposure and perioperative time management, compared to the use of fluoroscopy. Patients treated receiving an elective one- to three-level PLIF were retrospectively enrolled in the study. The surgery time, preparation time, operation room time, and effective dose (mSv) were analyzed for comparison of the radiation exposure and time consumption between cone-beam and fluoroscopy; Results: 214 patients were included (108 cone-beam navigated, and 106 traditional fluoroscopies). Using cone-beam navigation, reductions in the effective dose (2.23 ± 1.96 mSv vs. 3.39 ± 2.32 mSv, p = 0.002) and mean surgery time of 30 min (143.62 ± 43.87 min vs. 171.10 ± 48.91 min, p < 0.001) were demonstrated, which leveled out the extended preparation time of 7−8 min (37.25 ± 9.99 min vs. 29.65 ± 7.69 min, p < 0.001). These effects were fusion length dependent and demonstrated additional benefits in multisegmental surgeries. The cone-beam navigation system led to a reduction in the perioperative time requirements and radiation exposure. Furthermore, the controversially discussed longer preparation time when using cone-beam navigation was amortized by a shortened surgery time, especially in multilevel surgery.
本研究调查了基于锥束导航的标准化后路腰椎椎间融合术（PLIF）在辐射暴露和围手术期时间管理方面与使用荧光透视相比的优缺点。接受择期单节段至三节段PLIF治疗的患者被回顾性纳入研究。分析手术时间、准备时间、手术室时间和有效剂量（mSv），以比较锥束导航和荧光透视之间的辐射暴露和时间消耗；结果：纳入214例患者（108例采用锥束导航，106例采用传统荧光透视）。使用锥束导航，有效剂量降低（2.23±1.96 mSv对3.39±2.32 mSv，p = 0.002），平均手术时间缩短30分钟（143.62±43.87分钟对171.10±48.91分钟，p < 0.001），这抵消了延长的7 - 8分钟准备时间（37.25±9.99分钟对29.65±7.69分钟，p < 0.001）。这些效果与融合长度有关，并且在多节段手术中显示出额外的益处。锥束导航系统减少了围手术期时间需求和辐射暴露。此外，使用锥束导航时备受争议的较长准备时间通过缩短手术时间得到了弥补，尤其是在多节段手术中。
