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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Inverted C-arm Orientation During Simulated Hip Arthroscopic Surgery
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Inverted C-arm Orientation During Simulated Hip Arthroscopic Surgery

机译：模拟髋关节镜手术中的反转C臂方向

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Background: Fluoroscopic guidance is routinely utilized during hip arthroscopic surgery. Previous studies have shown that the C-arm orientation can significantly affect radiation exposure for both the surgeon and the patient during orthopaedic procedures. However, this has not been previously assessed for hip arthroscopic surgery. Hypothesis: Using an inverted C-arm during hip arthroscopic surgery will reduce radiation exposure to the patient and surgeon. Study Design: Descriptive laboratory study. Methods: A simulation study measured scatter radiation during hip arthroscopic surgery performed in the supine position under fluoroscopic guidance with an anthropomorphic pelvic phantom on a radiolucent operating table. Radiation exposure tested 2 different C-arm orientations: standard and inverted. Testing was performed at 6 locations corresponding to the patient, surgeon’s neck, surgeon’s waist, surgical technician, anesthesiologist, and radiology technician. Statistical analysis was performed using univariate and multivariate analyses assessing radiation exposure between the C-arm orientations. A risk calculation for carcinogenesis was performed based on reported radiation dosages. Results: Radiation exposure (in mGy/min) was more than 100-fold higher for the patient compared with the surgeon in both C-arm orientations. The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure when compared with the standard orientation (10.8 mGy/min vs 26.8 mGy/min, respectively). There was a small but significant increase in surgeon radiation exposure in the inverted orientation compared with the standard orientation (0.072 vs 0.067 mGy/min, respectively). The patient’s carcinogenesis risk was decreased 2.64-fold with the inverted orientation compared with the standard orientation (1.4 × 10 ~(–5) vs 3.7 × 10 ~(–5), respectively). Conclusion: The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure with a 2.64-fold decrease in the carcinogenesis risk compared with the standard orientation. Inadvertently, the inverted orientation provided a 9-cm increase in the surgeon’s working area. Our data supported the clinical utilization of the inverted C-arm orientation during hip arthroscopic surgery to minimize patient radiation exposure. Although there was a minimal but significant increase in surgeon radiation exposure with the inverted orientation, we believe that this is negligible when incorporated with standard leaded protective equipment as contrasted with the significant dose reduction for the patient as well as the decreased risk of carcinogenesis and hereditary disorders. Clinical Relevance: Patients undergoing hip arthroscopic surgery routinely acquire radiation exposure during the use of the C-arm. Measures to minimize radiation via the inverted C-arm orientation will decrease the unnecessary risk to the patient while continuing to allow for optimal treatment.
机译：背景：髋关节镜手术通常采用荧光检查指导。先前的研究表明，在整形外科手术过程中，C型臂的方向会严重影响外科医生和患者的放射线暴露。但是，以前尚未对髋关节镜手术进行评估。假设：在髋关节镜手术中使用倒置的C型臂将减少对患者和外科医生的辐射暴露。研究设计：描述性实验室研究。方法：一项模拟研究测量了在透视下在不透射线的手术台上以拟人化的骨盆体模在仰卧位进行的髋关节镜手术中在仰卧位进行的散射辐射。辐射暴露测试了2种不同的C臂方向：标准方向和倒置方向。在与患者，外科医生的脖子，外科医生的腰部，外科技术人员，麻醉师和放射技术人员相对应的6个位置进行了测试。使用单变量和多变量分析进行统计分析，以评估C臂方向之间的辐射暴露。根据报告的辐射剂量进行致癌风险计算。结果：在两个C臂方向上，患者的放射线暴露量（以mGy / min计）均比外科医生高100倍以上。与标准方向相比，倒置的C臂方向导致患者放射线暴露减少2.48倍（分别为10.8 mGy / min和26.8 mGy / min）。与标准方向相比，反转方向的外科医生放射线暴露量有少量但显着的增加（分别为0.072 vs 0.067 mGy / min）。与标准方向相比，倒置方向患者的致癌风险降低了2.64倍（分别为1.4×10〜（–5）和3.7×10〜（–5））。结论：与标准方向相比，倒C臂方向导致患者放射线暴露减少2.48倍，致癌风险降低2.64倍。不经意间，倒置方向使外科医生的工作区域增加了9厘米。我们的数据支持在髋关节镜手术中将C形臂倒置的临床应用，以最大程度地减少患者的辐射暴露。尽管外科医生的放射线照射方向相反，但放射线照射的增加最小但显着，但我们认为，与标准含铅防护设备结合使用时，这可以忽略不计，与降低患者剂量以及降低致癌性和遗传性风险相比，疾病。临床意义：进行髋关节镜手术的患者在使用C型臂时通常会受到放射线照射。通过反转C臂方向使辐射最小化的措施将减少患者不必要的风险，同时继续进行最佳治疗。

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