经皮椎体强化治疗过程中的辐射量与防护

The radiation dose and protection during percutaneous vertebral augmentation

背景:大量研究表明在经皮椎体强化治疗中的穿刺与骨水泥注射阶段,术者所受辐射量较高。目的:综述经皮椎体强化术中辐射量与防护措施的进展。方法:分别以"经皮椎体强化,辐射剂量,放射防护;percutaneous vertebral augmentation,radiation doses,radiation protective"为检索词,应用计算机检索万方数据库及PubM ed数据库1995年1月至2014年12月有关文章,纳入经皮椎体强化放射防护的文献。结果与结论:距离防护是基本的防护措施,术者应在不影响操作的情况下,尽量增加与放射线距离。此外术中C臂机的最优设置和最佳摆放、穿保护装置、放屏蔽设施、术中导航及对术者进行辐射方面培训等均可明显减少辐射量;改进骨水泥注射装置,包括遥控骨水泥注射技术,使其更方便操作且不增加患者辐射量;此外手术床对放射量的影响还有待进一步研究。相信随着对放射防护研究的不断深入,椎体强化将会更安全地应用于临床。

BACKGROUND：A large number of literatures have shown that surgeons expose to a higher radiation dose during puncture and bone cement injection in percutaneous vertebral augmentation. OBJECTIVE：To review the research progress in radiation doses and safeguard procedures in percutaneous vertebral augmentation. METHODS： By using ＂percutaneous vertebral augmentation, radiation doses, radiation protective＂ as key words, we retrieved articles related to radiological protection during percutaneous vertebral augmentation published from January 1995 to December 2014 in Wangfang database and PubMed database. RESULTS AND CONCLUSION：One basic principle of radiation protection is that the radiation dose decreases rapidly with distance from the radioactive sources. Surgeons should maximize the distance from the radioactive sources as far as possible in case there is no effect on the operation. To optimize the setting and position of C-arm machine, wear protective devices and put lead shields as wel as computer navigation and radiation training in surgeons al can help to reduce the radiation doses during percutaneous vertebral augmentation. Remote bone cement injection device is easy to control but not increases the radiation doses. In addition, the influence of surgery bed on radiation dose remains to be further studied. We believe that with the in-depth research on radiological protection, vertebral augmentation technique wil be safer in clinical application.