Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
J Hand Surg Am. 2023 Nov;48(11):1105-1113. doi: 10.1016/j.jhsa.2023.07.013. Epub 2023 Sep 6.
Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs).
We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023. All cases performed on or after January 1, 2022 used an intraoperative radiograph counter, referred to as a "shot-clock" (SC) group. Cases prior to this date were performed without a SC and served as a control group (NoSC group). Baseline demographics, fracture, and surgical characteristics were recorded. Final intraoperative radiographs were reviewed to record reduction parameters (radial inclination, volar tilt, and ulnar variance). REEs, fluoroscopy exposure times, and total radiation doses milligray (mGy) were compared between groups.
A total of 160 ORIF DRF cases were included in the NoSC group, and 135 were included in the SC group. The NoSC group had significantly more extra-articular fractures compared with the SC group. Reduction parameters after ORIF were similar between groups. The mean number of REEs decreased by 48% in the SC group. Cases performed with the SC group had significantly lower total radiation doses (0.8 vs 0.5 mGy) and radiation exposure times (41.9 vs 24.2 seconds). Mean operative times also decreased for the SC group (70 minutes) compared with that for the NoSC group (81 minutes).
A real-time intraoperative radiograph counter was associated with decreased REEs, exposure times, and total radiation doses during ORIF DRFs. Cases performed with a SC had significantly shorter operative times without compromising reduction quality. Using an intraoperative SC counter during cases requiring fluoroscopy may aid in decreasing radiation exposure, which serves as an occupational hazard for hand and upper-extremity surgeons.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
职业辐射暴露可能对外科医生的健康产生不良影响。本研究旨在确定术中实时射线计数器的使用是否会减少桡骨远端骨折（DRF）切开复位内固定（ORIF）术中的辐射暴露事件（REE）。
我们回顾了 2021 年 1 月至 2023 年 2 月在一家中心进行的所有孤立性 DRF ORIF 病例。2022 年 1 月 1 日及之后进行的所有病例均使用术中射线计数器，称为“射击时钟”（SC）组。在此日期之前进行的病例没有使用 SC，作为对照组（NoSC 组）。记录基线人口统计学、骨折和手术特征。最后对术中射线照片进行评估，以记录复位参数（桡骨倾斜度、掌倾角和尺侧差异）。比较两组之间的 REE、透视曝光时间和总辐射剂量毫戈瑞（mGy）。
NoSC 组共纳入 160 例 DRF ORIF 病例，SC 组纳入 135 例。NoSC 组的关节外骨折明显多于 SC 组。ORIF 后的复位参数在两组之间相似。SC 组的 REE 平均减少了 48%。使用 SC 组的病例总辐射剂量（0.8 与 0.5 mGy）和辐射暴露时间（41.9 与 24.2 秒）显著降低。与 NoSC 组相比，SC 组的平均手术时间也缩短（70 分钟）。
实时术中射线计数器与桡骨远端骨折 ORIF 术中 REE、曝光时间和总辐射剂量减少有关。使用 SC 进行的病例操作时间明显缩短，而不会影响复位质量。在需要透视的病例中使用术中 SC 计数器可能有助于减少辐射暴露，这是手部和上肢外科医生的职业危害。
研究类型/证据水平：治疗性 II 级。
