CAJ | 학술논문

目的：探讨采用精确定位法透视在胸腰段脊柱骨折椎弓根钉-棒系统内固定术中减少辐射暴露的效果。方法2010年3月至2012年10月，92例胸腰段脊柱骨折患者接受后路椎弓根钉-棒系统复位固定手术，采用精确定位法透视44例，传统定位法透视48例。精确定位法透视系在麻醉后透视，取得理想的透视视野后在地面标记“C”型臂X线机的位置，并记录X线机机臂的各姿态参数。术中再次透视时即根据记录确定X线机位置和姿态。记录并比较两组术前、术中X线曝光次数、曝光时间、透视时间和总手术时间。结果精确定位组术前的曝光次数、曝光时间和透视时间分别为（5.50±2.47）次、（2.26±1.05）s和（9.83±3.67）min，均高于传统组的（4.02±2.42）次、（1.78±0.98）s和（8.29±3.52）min；精确定位组在术中的曝光次数、曝光时间和透视时间分别为（5.25±3.64）次、（2.24±1.24）s和（10.39±4.82）min，均低于传统组的（9.73±4.38）次、（4.21±2.38）s和（24.69±6.35）min；精确定位组总曝光次数、总曝光时间、总透视时间和总手术时间上分别为（10.75±4.16）次、（4.50±1.83）s、（20.22±5.03）min和（70.52±18.33）min，也均低于传统组的（13.75±5.31）次、（5.99±3.27） s、（32.98±7.83）min和（81.86±21.57）min；差异均有统计学意义。精确定位组在术中和总定位准确率均高于传统组。结论采用精确定位法透视能有效地减少胸腰段脊柱骨折椎弓根钉-棒系统内固定术中的透视次数和辐射剂量，缩短透视时间和手术时间。
목적：탐토채용정학정위법투시재흉요단척주골절추궁근정-봉계통내고정술중감소복사폭로적효과。방법2010년3월지2012년10월，92례흉요단척주골절환자접수후로추궁근정-봉계통복위고정수술，채용정학정위법투시44례，전통정위법투시48례。정학정위법투시계재마취후투시，취득이상적투시시야후재지면표기“C”형비X선궤적위치，병기록X선궤궤비적각자태삼수。술중재차투시시즉근거기록학정X선궤위치화자태。기록병비교량조술전、술중X선폭광차수、폭광시간、투시시간화총수술시간。결과정학정위조술전적폭광차수、폭광시간화투시시간분별위（5.50±2.47）차、（2.26±1.05）s화（9.83±3.67）min，균고우전통조적（4.02±2.42）차、（1.78±0.98）s화（8.29±3.52）min；정학정위조재술중적폭광차수、폭광시간화투시시간분별위（5.25±3.64）차、（2.24±1.24）s화（10.39±4.82）min，균저우전통조적（9.73±4.38）차、（4.21±2.38）s화（24.69±6.35）min；정학정위조총폭광차수、총폭광시간、총투시시간화총수술시간상분별위（10.75±4.16）차、（4.50±1.83）s、（20.22±5.03）min화（70.52±18.33）min，야균저우전통조적（13.75±5.31）차、（5.99±3.27） s、（32.98±7.83）min화（81.86±21.57）min；차이균유통계학의의。정학정위조재술중화총정위준학솔균고우전통조。결론채용정학정위법투시능유효지감소흉요단척주골절추궁근정-봉계통내고정술중적투시차수화복사제량，축단투시시간화수술시간。
Objective To study the effect of precise locating technique of C?arm fluoroscopy in order to reduce the radia?tion exposure during the surgical procdure for thoracolumbar fracture. Methods From March 2010 to Octorber 2012, a total of 92 cases with thoracolumbar fracture underwent postierior internal fixation procdures with pedicle instrumentation. C?arm fluoros?copy was used in 44 cases with precise locating technique, while in 48 cases with traditional methods. In precise locating group,C?arm fluoroscopy was used after anesthesia. Once an ideal view was got, the position parameters of C?arm fluoroscopy machine were recorded. The machine was positioned according to the recording for the secondary fluoroscopy. Pre?operative and intra?operative number of times of exposure, length of exposure time, time for fluoroscopy and total operating time were recorded and compared be?tween two groups. Results Pre?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.51±2.47), (2.26±1.05) s and (9.83±3.67) min,which were higher than those of (4.02±2.42), (1.78±0.98) s and (8.29± 3.52) min in traditional group. However, intra?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.26±3.64), (2.24±1.24) s and (10.39±4.82) min,which were lower than those of (9.74±4.38), (4.21± 2.38) s and (24.69±6.35) min in traditional group,and total number of times of exposure, exposure time, time for fluoroscopy and total operating time in precise locating group were(10.77±4.16), (4.50±1.83) s, (20.22±5.03) min and(70.52±18.33)min,which were also lower than those of (13.76±5.31), (5.99±3.27) s , (32.98±7.83) min and(81.86±21.57)min in traditional group. Conclu?sion Precise locating technique of C?arm fluoroscopy reduces the radiation exposure during the surgical procdure for thoracolum?bar fracture.