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[移动C形臂术中成像:技术、图像生成与辐射防护]

[Intraoperative imaging with the mobile C-arm : Technique, image creation and radiation protection].

作者信息

Meurer Felix

机构信息

Sektion Muskuloskelettale Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.

出版信息

Unfallchirurgie (Heidelb). 2023 Dec;126(12):917-920. doi: 10.1007/s00113-023-01379-w. Epub 2023 Oct 20.

DOI:10.1007/s00113-023-01379-w
PMID:37861805
Abstract

Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance, documentation and monitoring of the corresponding treatment. Procedures such as open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) of fractures, kyphoplasty and vertebroplasty as well as posterior stabilization of spinal fractures are carried out under X‑ray control. In the relevant operating rooms of emergency departments and operating theaters, mobile fluoroscopy devices are available, which due to their appearance are called C‑arms. These devices can be moved horizontally, vertically, and along the pivotal axis, enabling real-time imaging of joints and bones from various angles. This imaging enables minimally invasive surgical techniques as this often eliminates the need for extensive preparation and resulting in smaller wound defects compared to open surgical preparation. Additionally, surgeons can immediately assess and, if necessary, adjust the reduction outcome to achieve the best possible care and reduce the need for corrective interventions. With current C‑arms it is also possible to generate 3‑dimensional datasets, to enhance the assessment of implant positioning, particularly in complex intra-articular fractures. This availability helps avoid subsequent corrective interventions that would otherwise only be identified through postoperative computed tomography [1].

摘要

骨科与创伤外科领域的成像技术不仅对诊断至关重要,而且在相应治疗的实施、记录和监测中也发挥着核心作用。诸如骨折的切开复位内固定术(ORIF)和闭合复位内固定术(CRIF)、椎体后凸成形术和椎体成形术以及脊柱骨折的后路稳定术等手术都是在X线控制下进行的。在急诊科和手术室的相关手术间里,有可移动的荧光透视设备,因其外形被称为C形臂。这些设备可以水平、垂直以及绕枢轴移动,能够从各个角度对关节和骨骼进行实时成像。这种成像使得微创外科技术成为可能,因为与开放手术准备相比,这通常无需进行广泛的准备工作,从而产生较小的伤口缺损。此外,外科医生可以立即评估并在必要时调整复位结果,以实现最佳治疗效果并减少进行纠正性干预的必要性。利用当前的C形臂,还能够生成三维数据集,以加强对植入物定位的评估,特别是在复杂的关节内骨折中。这种功能有助于避免后续那些原本只能通过术后计算机断层扫描才能发现的纠正性干预 [1]。

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Unfallchirurgie (Heidelb). 2023 Dec;126(12):917-920. doi: 10.1007/s00113-023-01379-w. Epub 2023 Oct 20.
2
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