Exposure of the orthopaedic surgeon to radiation.
Exposure of the orthopaedic surgeon to radiation.
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整形外科医生暴露于辐射。
DOI：
10.2106/00004623-199406000-00023
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发表时间：
1994
期刊：
影响因子：
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通讯作者：
S. Riley
中科院分区：
文献类型：
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作者：
S. Riley
对65例在X线透视辅助下进行的骨科手术进行了前瞻性研究，以确定主要骨科医生的辐射风险。辐射监测使用的通用薄膜徽章放置在衣领外的铅围裙，和气体消毒热释光剂量计环戴在每只手上。每次手术都要更换环，但同一个胶片徽章从一个外科医生转移到另一个外科医生。记录了外科医生的手优势、手术持续时间、手术类型和使用荧光透视的总时间。该研究在21例髓内钉手术（13例涉及远端锁定）、40例切开复位内固定（钢板和螺钉）和4例外固定手术中进行。所有徽章和戒指都被提交了一份关于辐射暴露的报告。未发现辐射暴露阅读阳性的环与手术持续时间之间存在关系。同样，正阅读和外科医生的手优势之间也没有相关性。环未显示阳性阅读组的透视平均持续时间为2.3分钟，环显示阳性阅读组的透视平均持续时间为4.7分钟。这是一个显著差异（p < 0.0001）。在使用荧光镜不到1.7分钟的手术中，没有任何环的辐射暴露阳性阅读。根据通用胶片徽章的读数，研究期间的总累积辐射量为0.0毫雷姆。从热释光剂量计环的读数是 * 没有任何形式的好处已经收到或将收到从一个商业方直接或间接地与本文的主题。没有收到支持这项研究的资金。t佛罗里达骨科研究所，地址：4175 East Fowler Avenue，坦帕，佛罗里达33617-2011。请向桑德斯博士提出重印请求。1纽约州纽约东17街301号骨科研究所关节疾病医院。10003.§ Loyola大学医学中心骨科，2160 South First Avenue，Maywood，Illinois 60153。i放射科，坦帕总医院，One Davis Island，坦帕，佛罗里达33601。人口科学系，福克斯蔡斯癌症中心，7701 Burholm大道，福克斯蔡斯，宾夕法尼亚州19111。在65例手术中，有8例（12%）的辐射暴露呈阳性;每例手术的平均剂量为9.85毫雷姆。与其他类型的手术（平均持续时间，2.1分钟）相比，髓内钉手术（平均持续时间，3.6分钟）期间使用荧光镜的时间更长。21例髓内钉手术中有29%（6例）的辐射暴露读数为阳性，而其他44例手术中只有5%（2例）（p < 0.01）。对于二十一次髓内钉手术的子集，根据环记录，每次手术的平均辐射剂量为二十八毫雷姆。最高平均辐射剂量（100毫雷姆）记录在涉及股骨近端和远端交锁髓内钉的手术过程中。在荧光镜辅助下完成的手术可以减少软组织的失活，因为手术暴露的范围减少了。然而，对于外科医生来说，一个潜在的危险是手部暴露于辐射的增加。一个可以作为例子的常见手术是在髓内钉固定过程中插入远端螺钉，但较新的技术，如用空心螺钉经皮固定骨折也引起了关注。这使我们评估了在一系列采用荧光镜引导治疗骨折的手术中，主要骨科医生的手实际暴露于辐射中。材料与方法在1990年12月至1991年2月的三个月期间，对初次骨科手术医生的手进行了一项研究，以评估其对辐射的暴露。每一次手术的主刀医生要么是一名主要关注创伤的骨科主治医生，要么是骨科创伤服务中心的一名研究员。主刀医生从来不是骨科住院医师。本研究以这种方式设计，以便我们能够更准确地估计社区环境中经验丰富的骨科医生的手术时间。在研究中仔细遵循标准荧光镜检查技术348。一条铅围裙围在躯干的前面。在进行成像时，外科医生始终面对机器，
A prospective study of sixty-five orthopaedic procedures performed with fluoroscopic assistance was undertaken to determine the risk to the primary orthopaedic surgeon with regard to radiation. Radiation was monitored with the use of a universal film badge placed outside the collar of a lead apron, and a gas-sterilized thermoluminescent dosimeter ring worn on each hand. The rings were changed with every operation, but the same film badge was transferred from surgeon to surgeon. The hand dominance of the surgeon, the duration of the operative procedure, the type of operation, and the total time that fluoroscopy had been used were noted. The study was conducted during twenty-one intramedullary nailing procedures (thirteen involving distal locking), forty open reductions with internal fixation (plates and screws), and four external-fixation procedures. All of the badges and rings were submitted for a report regarding radiation exposure. No relationship was found between a ring with a positive reading for exposure to radiation and the duration of the operation. Similarly, there was no correlation between a positive reading and the surgeon’s hand dominance. The mean duration ofthe fluoroscopy was 2.3 minutes for the group for which the rings did not show a positive reading and 4.7 minutes for the group for which the rings did show a positive reading. This was a significant difference (p < 0.0001). There was no positive reading for exposure to radiation from any ring that had been worn during a procedure in which the fluoroscope had been used for less than 1.7 minutes. According to the readings from the universal film badges, the total cumulative exposure to radiation for the duration of the study was 0.0 millirems. The readings from the thermoluminescent dosimeter rings were *No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. tThe Florida Orthopaedic Institute, 4175 East Fowler Avenue, Tampa, Florida 33617-2011. Please address requests for reprints to Dr. Sanders. 1The Hospital forJoint Diseases,Orthopaedic Institute,301 East 17th Street, New York, N.Y. 10003. §Department of Orthopaedics, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153. ciDepartment of Radiology, Tampa General Hospital, One Davis Island, Tampa, Florida 33601. #Department of Population Science, Foxchase Cancer Center, 7701 Burholm Avenue,Foxchase,Pennsylvania 19111. positive for exposure to radiation for eight (12 per cent) of the sixty-five procedures; the average dose was 9.85 millirems for each procedure. Fluoroscopy was used for a longer duration during the intramedullary nailing procedures (mean duration, 3.6 minutes) than during the other types of operations (mean duration, 2.1 minutes). The readings for exposure to radiation were positive for 29 per cent (six) of the twenty-one intramedullary nailing procedures, compared with 5 per cent (two) of the other forty-four operations (p < 0.01). For the subset of twenty-one intramedullary nailing procedures, the average dose of radiation for each procedure, as recorded by the rings, was twentyeight millirems. The highest average dose of radiation (100 millirems) was recorded during the procedures involving femoral nailing with both proximal and distal interlocking. Procedures done with fluoroscopic assistance can result in less devitalization of soft tissue because the extent of the operative exposure is decreased. However, one potential hazard for the surgeon is increased exposure of the hands to radiation. A common procedure that can serve as an example is insertion of a distal screw during intramedullary nailing, but newer techniques such as percutaneous fixation of fractures with cannulated screws also raise concerns. This led us to evaluate the actual exposure of the hands of the primary orthopaedic surgeon to radiation during a series of operations for the treatment of fractures in which fluoroscopic guidance was employed. Materials and Methods During the three-month period of December 1990 to February 1991, a study was undertaken to evaluate exposure of the hands of the primary orthopaedic surgeon to radiation. Either an attending orthopaedic surgeon whose main interest was trauma, or a fellow on the Orthopaedic Trauma Service, was the primary surgeon for each operation. The primary surgeon was never an orthopaedic resident. The study was designed in this way so that we could more accurately approximate the operative times for experienced orthopaedic surgeons in a community setting. Standard fluoroscopic techniques were carefully followed in the study348. A lead apron was worn over the anterior aspect of the trunk. The surgeon always faced the machine when imaging was taking place, so that the