同心球定位导向技术对椎间孔镜术辐射暴露的影响

Influence of using concentric sphere navigation device on radiation exposure in percutaneous transforaminal endoscopy

[目的]评估同心球定位导向技术对椎间孔镜辐射剂量及其相关疾病风险的影响。[方法]回顾性分析2015年10月~2016年8月共127例行经皮椎间孔镜椎间盘切除患者的资料。其中,64例采用同心球定位导向技术进行辅助穿刺的病例被视为导向组,63例采用常规手动盲穿的患者被视为常规组。观察比较穿刺次数、C型臂X线机透视次数及总曝光时间、手术时间和估算的辐射剂量及相关疾病的风险。[结果]平均穿刺次数导向组为(1.59±0.66)次,常规组为(4.83±1.76)次;总透视次数导向组为(27.38±5.11)次,常规组为(36.97±7.52)次;总曝光时间导向组为(26.27±4.75)秒,常规组为(33.51±7.08)秒;辐射有效剂量导向组为(0.49±0.09)mSv,常规组为(0.63±0.14)mSv;癌症风险导向组为(26.75±4.89)×10^(-9),常规组为(34.39±7.50)×10^(-9);遗传疾病风险导向组为(0.97±0.18)×10^(-9),常规组为(1.25±0.27)×10^(-9);导向组手术时间(62.91±10.03)min,常规组(69.84±10.49)min;以上指标两组间比较差异均具有统计学意义(P<0.001)。两组患者的满意度和并发症的差异皆无统计学意义(P>0.05)。[结论]同心球定位导向技术可以明显提高椎间孔镜穿刺的准确性,减少手术时间,降低患者辐射有效剂量,进而降低患者罹辐射相关病症、遗传疾病的风险。

[Objective] To investigate effect of using concentric sphere navigation device （CSND） on radiation exposure and radiation-related disease in percutaneous transforaminal endoscopic lumbar discectomy （PTELD） . [Method] This study retrospectively assessed the medical records of 127 patients who underwent PTELD from October2015 to August 2016. Of them, 64 patients who received the puncture using CSND were regarded as the navigation group, while the remaining 63 patients who underwent the conventional puncture methods were considered as the routine group. Puncture times, fluoroscop, ic times, time of radiation exposure, operation time, estimated radiation dose and risk of relative disease were compared between the 2 groups. [Result] There were statistically significant differences between the navigation group and the routine group in the average puncture times （1.59±0.66 versus 4.83±1.76, P〈0.001 ） , the total fluoroscopic times （27.38±5.11 versus 36.97± 7.52, P〈0.001） , the total exposure time （26.27±4.75 s versus 33.51±7.08 s, P〈0.001） and the operation time （62.91±10.03 min versus 69.84± 10.49 min, P〈0.001 ） . In addition, the navigation group was significantly inferior to the routine group in the estimated radiation dose （0.49±0.09 mSv versus 0.63±0.14 mSv, P〈0.001 ） , the estimated risk of cancer [ （26.75± 4.89） ×10-9 versus （34.39±7.50） ×10-9, P〈0.001] and the estimated risk of genetic diseases [ （0.97±0.18） ×10-9 versus （1.25±0.27） × 10-9, P〈0.001 ] . However, there was no significant differenoe in ratios of satisfaction and complication between the two groups （P〉0.05） . [Conclusion] The concentric sphere navigation device does significantly improve the puncture accuracy, decrease the operation time and radiation exposure as well, which might reduce the risks of cancer and genetic disease.