Department of Orthopaedics and Traumatology, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
BMC Musculoskelet Disord. 2024 Nov 20;25(1):933. doi: 10.1186/s12891-024-08056-y.
With the assistance of smart fixator technologies, the correction of complex deformities has been facilitated; however, the accurate integration of specialized radiographs and measurements into the system remains the greatest disadvantage, necessitating specialized imaging and an experienced team. When inexperienced technicians and doctors perform these specialized postoperative radiographs, excessive exposure of the patient and team to radioactive rays exacerbates inadequacies in measurements and delays the correction of residual deformities due to angular and translational adjustments. In this study, we compared postoperative measurements with those taken peroperatively via fluoroscopy, hypothesizing that it reduces the exposure of the patient and team to radioactive rays, allows for more accurate and timely correction of deformities and assembly parameters, and reduces time and costs.
Between 2013 and 2022, 84 patients with bone deformities were retrospectively reviewed. All patients had bone deformities and were treated with computer-assisted circular external fixator systems (Ca-CEF). Assembly parameter measurements began to be corrected via artificial neural network software via peroperative fluoroscopy in 37 patients and postoperative radiography in 47 patients. The surgical duration for all patients, peroperative measurement values, and number of radiographs taken on postoperative day 1, week, and month until deformity correction were recorded.
The duration until deformity correction was shorter in patients who underwent postoperative measurements (mean 50.24 days) than in those who underwent peroperative measurements (mean 42.31 days), but this difference was not statistically significant (p = 0.102). The surgical duration was significantly shorter in patients with postoperative measurements (mean of 130.37 min) than in those with peroperative measurements (mean of 155.88 min) (p = 0.045). For patients with postoperative measurements, 56.04 postoperative radiographs were taken. In contrast, patients with peroperative measurements had fewer radiographs totaling 28.7. This difference was statistically significant (p < 0.01). There was no statistically significant difference in the fluoroscopy dose between patients with postoperative measurements (mean 18.54 mGy) and those with peroperative measurements (mean 22.22 mGy) (p = 0.105).
To achieve accurate assembly parameters, minimizing X-ray exposure is crucial but can pose challenges. Our results showed that despite an average increase of 25 min in surgical duration, the time taken for deformity correction was shorter. Additionally, we obtained fewer postoperative radiographs, indicating reduced radiation exposure.
在智能固定器技术的辅助下，复杂畸形的矫正变得更加容易；然而，将专门的影像学检查和测量准确地整合到系统中仍然是最大的难题，这需要专门的影像学检查和有经验的团队。当经验不足的技师和医生进行这些专门的术后影像学检查时，患者和团队会过度暴露在放射性射线中，这会导致测量不准确，并延迟因角度和位移调整而导致的残余畸形的矫正。在这项研究中，我们通过荧光透视术对术后测量值与术中测量值进行了比较，假设这可以减少患者和团队的射线暴露，允许更准确和及时地矫正畸形和装配参数，并减少时间和成本。
2013 年至 2022 年，我们回顾性分析了 84 例骨畸形患者。所有患者均有骨畸形，并接受计算机辅助环形外固定架系统（Ca-CEF）治疗。在 37 例患者中，我们开始通过术中荧光透视术和术后影像学检查来校正装配参数测量值，在 47 例患者中，我们开始通过术后影像学检查来校正装配参数测量值。记录所有患者的手术时间、术中测量值以及术后第 1、1 周和 1 月拍摄的 X 线片数量，直到畸形矫正。
接受术后测量的患者（平均 50.24 天）达到畸形矫正的时间短于接受术中测量的患者（平均 42.31 天），但差异无统计学意义（p=0.102）。接受术后测量的患者的手术时间（平均 130.37 分钟）明显短于接受术中测量的患者（平均 155.88 分钟）（p=0.045）。对于接受术后测量的患者，共拍摄了 56.04 张术后 X 线片。相比之下，接受术中测量的患者总共拍摄了 28.7 张 X 线片，差异有统计学意义（p<0.01）。接受术后测量的患者的荧光透视剂量（平均 18.54 mGy）与接受术中测量的患者（平均 22.22 mGy）的差异无统计学意义（p=0.105）。
为了获得准确的装配参数，减少 X 射线的暴露至关重要，但这可能会带来挑战。我们的结果表明，尽管手术时间平均增加了 25 分钟，但畸形矫正的时间更短。此外，我们拍摄的术后 X 线片更少，表明辐射暴露减少。
