骨质疏松性椎体压缩性骨折经皮椎体强化术中辐射剂量与辐射防护的研究
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摘要
目的探讨骨质疏松性椎体压缩性骨折经皮椎体强化术中医生受照射辐射剂量与减少辐射危害的途径与方法。方法选取2015年1月—2016年12月北方学院附属第一医院骨外科收治的骨质疏松性椎体压缩骨折180例,按照定位方法和透视时距离手术台位置不同,分为3组,每组60例。均由同一名手术医生运用经皮椎体强化术治疗,A、B两组施术医生全程位于手术台旁;A组术中运用常规克氏针定位骨折部位,B组运用体表定位器定位骨折部位,C组运用常规克氏针定位,医生透视时离开手术台1.5 m。比较各组定位准确率、透视次数、手术时间、辐射时间、骨水泥注射量以及术前术后疼痛VAS评分,监测记录术者眼睛、甲状腺、前胸、右手腕等暴露部位的辐射剂量,并提出减少辐射剂量的建议和方案。结果手术时间、辐射时间、骨水泥注射量、术前、术后VAS评分等指标3组比较差异均无统计学意义(P>0.05);B组准确定位率和透视次数明显优于A组和C组(P<0.05)。3组眼睛、甲状腺、前胸、右手腕等暴露部位所受的辐射剂量比较,C组各部位受照辐射剂量明显低于B组,B组各部位受照辐射剂量明显低于A组(P<0.05)。结论经皮椎体强化术透视时利用体表定位器和医生距离手术台1.5 m,可以有效减少受照辐射剂量,还不影响手术效果,是比较有效的防辐射保护方式。
Objective To investigate radiation exposure doses and ways of reducing radiation hazards in medical staff during percutaneous vertebral augmentation surgery for osteoporotic compression fractures of vertebral body. Methods A total of 180 patients with osteoporotic compression fractures of vertebral body admitted during January 2015 and December 2016 were divided into group A,B and C( n = 60 for each group) according to location methods and different positions from operating table during fluoroscopy. All percutaneous vertebral augmentation surgeries were performed by the same surgeon,and the surgeon located next to the operating table in group A and B,while conventional Kirschner wire and surface locator were respectively used to locate the fracture site in groups A and B; group C was used conventional Kirschner to locate the fracture site,while the surgeon was at 1. 5 m from the operating table when fluoroscopy was beginning. In three groups,positioning accuracy rate,fluoroscopy frequency,operative time,radiation duration,bone cement injection volume and preoperative and postoperative visual analogue scales( VAS) scores were compared,and radiation doses of exposed parts such as eye,thyroid gland,prothorax and right wrist were monitored and recorded,and then suggests and programmes of reducing radiation doses were given. Results There were no significant differences in indexes such as operation time,radiation duration,bone cement injection volume and preoperative and postoperative VAS scores among three groups( P > 0. 05). Positioning accurate rate and fluoroscopy frequency in group B were superior to those in group A and C( P < 0. 05). Radiation doses of exposed parts such as eye,thyroid gland,prothorax and right wrist in group C were significantly lower than those in group B,and the doses in group B were significantly lower than those in group A( P < 0. 05). Conclusion Surgeons are at 1. 5 M from the operating table when fluoroscopy for percutaneous vertebral augmentation surgery is beginning and use of surface locator may effectively reduce exposure dose without affecting clinical effectiveness for osteoporotic compression fractures of vertebral body,and it is an effective way of radiation protection.
Objective To investigate radiation exposure doses and ways of reducing radiation hazards in medical staff during percutaneous vertebral augmentation surgery for osteoporotic compression fractures of vertebral body. Methods A total of 180 patients with osteoporotic compression fractures of vertebral body admitted during January 2015 and December 2016 were divided into group A,B and C( n = 60 for each group) according to location methods and different positions from operating table during fluoroscopy. All percutaneous vertebral augmentation surgeries were performed by the same surgeon,and the surgeon located next to the operating table in group A and B,while conventional Kirschner wire and surface locator were respectively used to locate the fracture site in groups A and B; group C was used conventional Kirschner to locate the fracture site,while the surgeon was at 1. 5 m from the operating table when fluoroscopy was beginning. In three groups,positioning accuracy rate,fluoroscopy frequency,operative time,radiation duration,bone cement injection volume and preoperative and postoperative visual analogue scales( VAS) scores were compared,and radiation doses of exposed parts such as eye,thyroid gland,prothorax and right wrist were monitored and recorded,and then suggests and programmes of reducing radiation doses were given. Results There were no significant differences in indexes such as operation time,radiation duration,bone cement injection volume and preoperative and postoperative VAS scores among three groups( P > 0. 05). Positioning accurate rate and fluoroscopy frequency in group B were superior to those in group A and C( P < 0. 05). Radiation doses of exposed parts such as eye,thyroid gland,prothorax and right wrist in group C were significantly lower than those in group B,and the doses in group B were significantly lower than those in group A( P < 0. 05). Conclusion Surgeons are at 1. 5 M from the operating table when fluoroscopy for percutaneous vertebral augmentation surgery is beginning and use of surface locator may effectively reduce exposure dose without affecting clinical effectiveness for osteoporotic compression fractures of vertebral body,and it is an effective way of radiation protection.
引文
[1]魏超,韩敦富,李涛.经皮椎体强化治疗过程中的辐射量与防护[J].中国组织工程研究,2015,19(21):3409-3413.
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[3]金鹏,孙钢.对经皮椎体强化术的再认识[J].介入放射学杂志,2016,25(6):463-468.
[4]赵锡鹏,田耘,孙全富.经皮椎体强化术中医生受照剂量与辐射防护研究[J].中国辐射卫生,2016,25(6):766-768.
[5]Panizza D,Barbieri M,Parisoli F,et al.Patient radiation exposure during different kyphoplasty techniques[J].Radiat Prot Dosimetry,2014,158(2):230-234.
[6]张义龙,唐佩福.骨质疏松性椎体压缩骨折的治疗进展[J].河北医学,2017,23(8):1398-1401.
[7]黄立军,夏庆福,王伟,等.单侧椎弓根旁入路经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折研究[J].现代仪器与医疗,2016,22(2):88-90.
[8]谢清华.椎体后凸成形术治疗骨质疏松性脊柱骨折的临床分析[J].中国当代医药,2013,20(32):176-177.
[9]周瑞明,管义红,王全兵,等.不同黏度骨水泥联合经皮椎体后凸成形术治疗骨质疏松椎体压缩性骨折的疗效[J].武警后勤学院学报:医学版,2017,26(6):509-511.
[10]Yen-Yao Li,Tsung-Jen H,Chin-Chang CH,et al.Comparing radiation exposure during percutaneous vertebroplasty using one-vs.two-fluoroscopic technique[J].BMC Musculoskelet Disord,2013,45(14):38.
[11]Struelens L,Schoonjans W,Schils F,et al.Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures[J].J Radiol Prot,2013,33(3):635-645.
[12]Schils F,Schoojans W,Struelens L.The surgeon's real dose exposure during balloon kyphoplasty procedure and evaluation of the cement delivery system:a prospective study[J].Eur Spine J,2013,22(8):1758-1764.
[13]郑钧正.我国电离辐射防护基本标准的沿革与进展[J].辐射防护通讯,2003,23(3):1-9,29.
[14]Do K H.The health effects of low-dose radiation exposure[J].Korean Med Assoc,2011,54(13):1253-1261.
[15]任丁,储辉,黄洪,等.胸腰椎微创手术体表定位器的研制及临床应用[J].中国骨与关节损伤杂志,2014,29(9):866-868.
[16]郝帅,马迅,陈晨,等.自制框型术前胸腰椎椎弓根定位器的设计与应用[J].山西医科大学学报,2017,48(2):184-187.
[17]罗亚平,常小波,王勤业.后路胸腰椎微创手术术前定位器的设计及临床应用[J].实用骨科杂志,2016,22(8):721-722.
[18]杨健,余永桂,曹洪等.经皮穿刺椎体后凸成形术与椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的效果比较[J].中国医药,2016,11(11):1676-1680.
[19]张斌,尚咏,史图龙等.经皮椎体后凸成形术后继发非手术椎体再骨折的相关因素分析[J].空军医学杂志,2014,30(2):96-98.
[20]王建儒,张奎渤,刘辉,等.经皮椎体后凸成形术术中不同辐射防护距离的对比研究[J].中国脊柱脊髓杂志,2014,24(5):417-421.
[2]陈建常,王防.PKP单侧与双侧入路治疗骨质疏松性椎体压缩性骨折比较[J].创伤与急危重病医学,2014,2(3):142-145,156.
[3]金鹏,孙钢.对经皮椎体强化术的再认识[J].介入放射学杂志,2016,25(6):463-468.
[4]赵锡鹏,田耘,孙全富.经皮椎体强化术中医生受照剂量与辐射防护研究[J].中国辐射卫生,2016,25(6):766-768.
[5]Panizza D,Barbieri M,Parisoli F,et al.Patient radiation exposure during different kyphoplasty techniques[J].Radiat Prot Dosimetry,2014,158(2):230-234.
[6]张义龙,唐佩福.骨质疏松性椎体压缩骨折的治疗进展[J].河北医学,2017,23(8):1398-1401.
[7]黄立军,夏庆福,王伟,等.单侧椎弓根旁入路经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折研究[J].现代仪器与医疗,2016,22(2):88-90.
[8]谢清华.椎体后凸成形术治疗骨质疏松性脊柱骨折的临床分析[J].中国当代医药,2013,20(32):176-177.
[9]周瑞明,管义红,王全兵,等.不同黏度骨水泥联合经皮椎体后凸成形术治疗骨质疏松椎体压缩性骨折的疗效[J].武警后勤学院学报:医学版,2017,26(6):509-511.
[10]Yen-Yao Li,Tsung-Jen H,Chin-Chang CH,et al.Comparing radiation exposure during percutaneous vertebroplasty using one-vs.two-fluoroscopic technique[J].BMC Musculoskelet Disord,2013,45(14):38.
[11]Struelens L,Schoonjans W,Schils F,et al.Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures[J].J Radiol Prot,2013,33(3):635-645.
[12]Schils F,Schoojans W,Struelens L.The surgeon's real dose exposure during balloon kyphoplasty procedure and evaluation of the cement delivery system:a prospective study[J].Eur Spine J,2013,22(8):1758-1764.
[13]郑钧正.我国电离辐射防护基本标准的沿革与进展[J].辐射防护通讯,2003,23(3):1-9,29.
[14]Do K H.The health effects of low-dose radiation exposure[J].Korean Med Assoc,2011,54(13):1253-1261.
[15]任丁,储辉,黄洪,等.胸腰椎微创手术体表定位器的研制及临床应用[J].中国骨与关节损伤杂志,2014,29(9):866-868.
[16]郝帅,马迅,陈晨,等.自制框型术前胸腰椎椎弓根定位器的设计与应用[J].山西医科大学学报,2017,48(2):184-187.
[17]罗亚平,常小波,王勤业.后路胸腰椎微创手术术前定位器的设计及临床应用[J].实用骨科杂志,2016,22(8):721-722.
[18]杨健,余永桂,曹洪等.经皮穿刺椎体后凸成形术与椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的效果比较[J].中国医药,2016,11(11):1676-1680.
[19]张斌,尚咏,史图龙等.经皮椎体后凸成形术后继发非手术椎体再骨折的相关因素分析[J].空军医学杂志,2014,30(2):96-98.
[20]王建儒,张奎渤,刘辉,等.经皮椎体后凸成形术术中不同辐射防护距离的对比研究[J].中国脊柱脊髓杂志,2014,24(5):417-421.