自制椎弓根螺钉角度定位仪减少术中X射线辐射及并发症的初步研究

Reduction of X-ray Radiation and Complication in Operation with A Self-designed Localizer

目的传统徒手椎弓根螺钉置钉术中透视时间长、辐射剂量大,且存在较大误置率,通过自制椎弓根螺钉角度定位仪辅助进钉,以减少术中辐射及并发症。资料与方法前瞻性地将40例胸腰段骨折患者随机分成研究组和对照组,每组20例。研究组借助自制椎弓根螺钉角度定位仪辅助进钉,对照组采用传统徒手置钉,比较两组术中透视时间、医患所受辐射剂量及并发症的差异。结果研究组每枚螺钉植入过程中透视的平均时间为（5.06±0.68）s,对照组为（14.69±1.86）s,两组差异有统计学意义（t=54.931,P〈0.05）。研究组患者术区所受辐射剂量为（65.31±5.52）u Sv/钉,施术者手部及晶状体所受辐射剂量为（58.59±6.48）u Sv/钉、（8.82±0.84）u Sv/钉;对照组分别为（199.37±15.36）u Sv/钉、（164.18±11.25）u Sv/钉、（27.37±2.52）u Sv/钉,研究组均较对照组低,差异有统计学意义（t=92.824、91.755、78.904,P〈0.05）。研究组并发症亦较对照组少,差异有统计学意义（χ~2=183.158,P〈0.05）。结论借助该自制椎弓根螺钉定位仪辅助进钉能减少术中透视时间,从而有效减少医患双方的辐射剂量,并能有效减少术中并发症。

Purpose Conventional freehand pedicle screw placement has long fluoroscopy time,high radiation dose and low accuracy.The aim of this study is to evaluate a new selfdesigned localizer used in conventional technique in order to decrease intraoperative X-ray radiation and postoperative complications.Materials and Methods In this prospective study,40 patients with thoracolumbar spinal fractures were randomly divided into study cohort and comparison cohort,each group with 20 patients.Patients in the study cohort were treated by self-designed localizer during operation.And the comparison cohort received freehand anatomic landmarks by doctor without new technique.Fluoroscopy time,intraoperative radiation dose and complications related to pedicle screw were compared between two groups respectively.Results The average intraoperative fluoroscopy time of each pedicle screw was（5.06±0.68） s in self-designed group compared to（14.69±1.86） s in freehand group,there was significant difference between the two groups（t=54.931,P〈0.05）.The average radioactive dose of the patients was（65.31±5.52） u Sv and（199.37±15.36） u Sv per screw in study and control groups,respectively.Differences in the average radiation dose between the two groups were marked（t=92.824,P〈0.05）.The average radiation dose of hands and eyes was（58.59±6.48） u Sv and（8.82±0.84） u Sv per screw in experimental group,with corresponding in control group（164.18±11.25） u Sv and（27.37±2.52） u Sv per screw,respectively,which was significantly different from that in experimental group（t=91.775 and 78.904,P〈0.05）.The complications of each group were also different significantly（χ~2=183.158,P0.05）.Conclusion The study demonstrates that the self-designed localizer can shorten fluoroscopy time and decrease the patients＇ and doctors＇ radiation dose exposed to vertebrae internal fixation operation,and also reduce postoperative complications related to the pedicle screw.