骨科术中成像的职业暴露及辐射安全

Occupational exposure to imaging in orthopedics and radiation safety

现代骨科手术中微创化已成趋势,其中对于术中成像的需求逐渐增多。良好的术中成像可以辅助骨外科医师精确定位解剖结构及放置内固定,然而术中成像不可避免地会让骨科医师及患者暴露在电离辐射中,而辐射暴露可通过诱导DNA损伤和活性氧的产生导致细胞损伤,这些损伤常常会导致细胞死亡或基因组不稳定,从而导致各种辐射相关病症,包括罹患恶性肿瘤的风险增加。虽然传统术中透视手术室会配备铅衣及铅领用来减少辐射暴露,但对于铅衣及铅领覆盖不到的部位是否安全不得而知。因此辐射安全已成为骨外科医师在术中成像中不可避免的一个问题,而如何有效减少及规避不必要的电离辐射暴露,对于骨外科医师及患者来说显得尤为重要。本文旨在对目前骨科术中成像的职业暴露及辐射安全进行综述。

Minimally invasive surgery has become a trend in modern orthopedic surgery, and the demand for intraoperative imaging has gradually increased. Good intraoperative imaging can assist the orthopaedic surgeon in accurately positioning the anatomy and placing the internal fixation. However, intraoperative imaging inevitably exposes the orthopaedic surgeon and patient to ionizing radiation, and radiation exposure can induce DNA damage and reactive oxygen species. Production results in cell damage that often leads to cell death or genomic instability leading to increased risk of various radiation-related conditions, including malignancy. Although the traditional intraoperative fluoroscopy operating room will be equipped with lead clothing and lead collar to reduce radiation exposure, it is not known whether the lead clothing and lead-covered parts are safe. Therefore, radiation safety has become an inevitable problem for orthopedic surgeons in intraoperative imaging, and how to effectively reduce and avoid unnecessary exposure to ionizing radiation is particularly important for bone surgeons and patients. This article aims to review the occupational exposure and radiation safety of intraoperative imaging in orthopaedic surgery.