脊柱微创手术中医护人员遭受的X线辐射损害及应对措施

X-ray radiation damage of medical staff in minimally invasive spine surgery and its countermeasures

目的探讨经皮内镜椎间盘切除伴椎间融合术中医护人员遭受的X线辐射的损害及应对措施。方法选择本科收治的行经皮内镜椎间盘切除伴椎间融合术的患者49例。术中X线照射采用飞利浦BV25型移动式C型臂X线机。术者手术过程中穿戴铅衣、铅围脖、含铅面罩、指环。分别检测术者身体不同部位和距辐射源不同距离的累计辐射剂量。结果防护设备外眼眶、左前胸、甲状腺、性腺的有效辐射剂量为(24.0±6.6)μSv、(96.5±15.2)μSv、(43.1±10.5)μSv、(82.4±20.6)μSv,防护设备内眼眶、左前胸、甲状腺、性腺的有效辐射剂量为(5.3±2.0)μSv、(3.5±4.7)μSv、(4.5±3.8)μSv、(7.5±2.4)μSv,防护设备内外的有效辐射剂量差异有统计学意义(P<0.05)。随着距辐射源距离的增加,累积辐射剂量显著降低,与1 m距离相比,2 m、3 m、4 m的累积辐射剂量均显著降低,差异有统计学意义(P<0.05)。结论脊柱微创手术中采取有效的措施防护医护人员遭受X线剂量辐射损害尤其重要,能够显著降低医护人员遭受X线辐射的剂量。

Objective To investigate X-ray radiation damage of medical staff in minimally invasive spine surgery and its countermeasures. Methods A total of 49 percutaneous endoscopic discectomy cases with interbody fusion in our hospital were selected,intraoperative X-ray radiation used PHILPS BV25 type mobile C-arm X-ray machine. The operator in the process wore lead clothes,lead collar,lead mask and rings. The cumulative radiation doses of different body parts and different radiation sources were detected. Results The radiation dose of outer eye socket,left chest,thyroid and gonad were（ 24. 0 ± 6. 6） μSv,（ 96. 5 ± 15. 2） μSv,（ 43. 1 ± 10. 5） μSv,（ 82. 4 ± 20. 6） μSv,respectively,and radiation dose of inner eye socket,left chest,thyroid and gonad were（ 5. 3 ±2. 0） μSv,（ 3. 5 ± 4. 7） μSv,（ 4. 5 ± 3. 8） μSv,and（ 7. 5 ± 2. 4） μSv. The difference was statistically significant in outside and inside radiation dosage of protective equipment（ P 〈0. 05）. The cumulative radiation dose was significantly decreased with the increase of distance from the source.Compared with 1 m distance,the cumulative radiation doses of 2 m,3 m and 4 m was significantly lower,and the difference was statistically significant（ P〈 0. 05）. Conclusion Effective measures to protect medical personnel from X-ray radiation damage in minimally invasive spine surgery is particularly important,it can significantly reduce the dose of X-ray radiation of medical staff.