精确定位法透视减少胸腰段脊柱骨折内固定术中的辐射暴露  

Precise locating fluoroscopy reduces radiation exposure during the surgical procdure for thoracolumbar fracture

作　　者：钱宇[1] 何磊 梁文清[1] 徐国健[1] 王磊[1] 赵凤东[2] 

机构地区：[1]绍兴市人民医院骨科,312000 [2]浙江大学医学院附属邵逸夫医院骨科

出　　处：《中华骨科杂志》2015年第8期849-853,共5页Chinese Journal of Orthopaedics

基　　金：浙江省卫生高层次创新人才培养工程项目（CXRC20140160000118）,浙江省公益性计划项目（2014C33150）,浙江省自然科学基金项目（LY15H060005）

摘　　要：目的探讨采用精确定位法透视在胸腰段脊柱骨折椎弓根钉-棒系统内固定术中减少辐射暴露的效果。方法2010年3月至2012年10月，92例胸腰段脊柱骨折患者接受后路椎弓根钉一棒系统复位固定手术，采用精确定位法透视44例，传统定位法透视48例。精确定位法透视系在麻醉后透视，取得理想的透视视野后在地面标记“C”型臂X线机的位置，并记录X线机机臂的各姿态参数。术中再次透视时即根据记录确定X线机位置和姿态。记录并比较两组术前、术中X线曝光次数、曝光时间、透视时间和总手术时间。结果精确定位组术前的曝光次数、曝光时间和透视时间分别为（5．50±2．47）次、（2．26±1．05）s和（9．83±3．67）min，均高于传统组的（4．02±2．42）次、（1．78±0．98）s和（8．29±3．52）min；精确定位组在术中的曝光次数、曝光时间和透视时间分别为（5．25±3．64）次、（2．24±1．24）s和（10．39±4．82）min，均低于传统组的（9．73±4．38）次、（4．21±2．38）s和（24．69±6．35）min；精确定位组总曝光次数、总曝光时间、总透视时间和总手术时间上分别为（10．75±4．16）次、（4．50±1．83）s、（20．22±5．03）min和（70．52±18．33）min，也均低于传统组的（13．75±5．31）次、（5．99±3．27）S、（32．98±7．83）min和（81．86±21．57）min；差异均有统计学意义。精确定位组在术中和总定位准确率均高于传统组。结论采用精确定位法透视能有效地减少胸腰段脊柱骨折椎弓根钉一棒系统内固定术中的透视次数和辐射剂量，缩短透视时间和手术时间。Objective To study the effect of precise locating technique of C-arm fluoroscopy in order to reduce the radia- tion exposure during the surgical procdure for thoracolumbar fracture. Methods From March 2010 to Octorber 2012, a total of 92 cases with thoracolumbar fracture underwent postierior internal fixation procdures with pedicle instrumentation. C-arm fluoroscopy was used in 44 cases with precise locating technique, while in 48 cases with traditional methods. In precise locating group, C- arm fluoroscopy was used after anesthesia. Once an ideal view was got, the position parameters of C-arm fluoroscopy machine were recorded. The machine was positioned according to the recording for the secondary fluoroscopy. Pre-operative and intra-operative number of times of exposure, length of exposure time, time for fluoroscopy and total operating time were recorded and compared between two groups. Results Pre-operatlve number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were （5.51 ±2.47）, （2.26± 1.05） s and （9.83±3.67） mix, which were higher than those of （4.02±2.42）, （1.78±0.98） s and （8.29± 3.52） mix in traditional group. However, intra-operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were （5.26±3.64）, （2.24±1.24） s and （10.39±4.82） mix, which were lower than those of （9.74±4.38）, （4.21± 2.38） s and （24.69±6.35） mix in traditional group, and total number of times of exposure, exposure time, time for fluoroscopy and total operating time in precise locating group were （ 10.77±4.16）, （4.50± 1.83） s, （20.22±5.03） mix and （70.52± 18.33 ） mix, which were also lower than those of （13.76±5.31）, （5.99±3.27） s, （32.98±7.83） mix and （81.86±21.57）mix in traditional group. Conclusion Precise locating technique of C-arm fluoroscopy reduces the radiation exposure during the surgical procdure for thoracolum bar fracture.

关 键 词：胸椎 腰椎 脊柱骨折 脊柱融合术 X线透视检查 

分 类 号：R687.3[医药卫生—骨科学]