经皮椎体后凸成形术术中不同辐射防护距离的对比研究

The effect of different distances to radiation resources for radiation protection in percutaneous kypho?鄄plasty

中文关键词:  辐射防护  距离  放射源  经皮椎体后凸成形术

英文关键词:Radiation protection, Distance, Radiation resources, Percutaneous kyphoplasty

中文摘要:

  【摘要】 目的：通过对比研究经皮椎体后凸成形术术中不同防护距离对X线辐射防护的影响，以探讨临床工作中适用的辐射防护方式。方法：将45例单节段椎体压缩骨折患者随机分为三组，每组采用不同方式进行辐射防护：A组，术者手术全程处于手术台旁； B组，术者透视时处于手术台旁1.5m（手术室内）；C组，术者透视时处于手术台旁4m（手术室外）。三组患者均接受由同一术者进行的PKP手术治疗，记录各组手术时间，并使用PRM-1200辐射仪监测记录术者眼睛、甲状腺、前胸、右手腕的辐射剂量与术前、术后VAS评分及术后并发症情况，进行统计学分析。结果：A、B两组的手术时间与C组手术时间相比，差异均有统计学意义（P<0.05）；但A、B两组之间的差异并无统计学意义（P>0.05）。三组的术中辐射时间及骨水泥注射量无明显差异（P>0.05）。3组的手术前及手术后VAS评分对比均无显著差异（P>0.05）。通过配对t检验分析得出，与手术前相比，各组患者的手术后VAS评分均有显著降低（P<0.05）。A组术者眼睛、甲状腺、前胸、右手腕的辐射剂量分别为0.362±0.087mSv，0.435±0.064mSv，0.494±0.106mSv，1.542±0.179mSv；B组分别为0.138±0.055mSv，0.156±0.031mSv，0.158±0.075mSv，0.204±0.121mSv；C组分别为0.112±0.039mSv，0.129±0.052mSv，0.120±0.083mSv，0.292±0.046mSv。各部位B、C两组的辐射值与A组相比差异均有统计学意义（P<0.05）。B、C两组相比，各个部位辐射值差异均无统计学意义（P>0.05）。三组手术病例术后均无神经损伤、肺栓塞等术后并发症。结论：PKP术中透视时远离放射源是较好的辐射防护方式；距离放射源1.5m既可以有效地降低辐射量，又不会增加手术时间，是较适用于临床且简便易行的方式。

英文摘要:

  【Abstract】 Objectives: To compare the effects of different distances to radiation resources for radiation protection in percutaneous kyphoplasty, and to find out the appropriate methods for clinical work. Methods: 45 patients admitted for single level osteoporotic vertebral compression fracture were divided into 3 groups randomly(group A, B and C): primary operator standing next to operating table for entire operation in group A; primary operator standing 1.5 meters and 4 meters from operating table during fluoroscopic time in group B and C respectively. All surgeries were performed by the same surgeon. The time of operation, duration and times of fluoroscopy, pre- and post-operative visual analogue scale(VAS) were recorded. Meanwhile, radiation doses in the sites of operator′s eyes, thyroid, chest and right wrist were recorded by 4 unprotected radiometers (PRM-1200) simultaneously. Results: The time of operation in group C was significantly more than that in group A and B(P<0.05) and there was no statistical difference on operation time between group A and B(P>0.05). There was no statistical difference on fluoroscopic time and volumes of cement among 3 groups(P>0.05). Either the pre- or the post-operative VAS showed no statistical difference among 3 groups(P>0.05). The post-operative VAS in 3 groups decreased significantly compared with pre-operative VAS respectively(P<0.05). In group A, the dose of radiation delivering to the eyes, thyroid, chest and right wrist was 0.362±0.087mSv, 0.435±0.064mSv, 0.494±0.106mSv and 1.542±0.179mSv, respectively. In group B, the radiation dose was 0.138±0.055mSv, 0.156±0.031mSv, 0.158±0.075mSv and 0.204±0.121mSv, respectively. In group C, the radiation dose was 0.112±0.039mSv, 0.129±0.052mSv, 0.120±0.083mSv and 0.292±0.046mSv, respectively. The radiation doses in eyes, thyroid, chest and right wrist in group A were significantly more than those in group B and C(P<0.05) and there was no statistical difference on radiation dose between group B and C in all 4 sites(P>0.05). No complication such as nerve injury or pulmonary embolism was found in two groups. Conclusions: Distance to radiation resources is a key element for radiation protection and 1.5 meters away from operating table is the best distance to achieve both good radiation protection and curative effect.