3D-navigation for SI screw fixation - How does it affect radiation exposure for patients and medical personnel?

Autor: Kalbas Y; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland. Electronic address: yannik.kalbas@usz.ch., Hoch Y; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Klingebiel FK; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Klee O; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Cester D; University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Halvachizadeh S; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Berk T; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Wanner GA; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Center for Spine Surgery and Trauma Surgery, Bethanien Hospital, Toblerstr. 51 8044 Zurich, Switzerland., Pfeifer R; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Pape HC; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland., Hasler RM; Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Ramistr. 100 8091 Zurich, Switzerland; Prodorso Center for Spine Medicine, Walchestr. 15 CH-8006 Zürich, Switzerland.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Feb; Vol. 55 (2), pp. 111214. Date of Electronic Publication: 2023 Nov 24.
DOI: 10.1016/j.injury.2023.111214
Abstrakt: Background: 3D-navigation for percutaneous sacroiliac (SI) screw fixation is becoming increasingly common and several studies report great advantages of this technology. However, there is still limited clinical evidence on the efficacy regarding radiation exposure for patient and personnel.
Methods: This is a retrospective, single-center cohort study. All patients who underwent percutaneous sacroiliac screw fixation for an injury of the posterior pelvic ring from 2014 to 2021 were screened. Inclusion criteria were: conclusive radiation dosage reports, signed informed consent, a twelve month follow up and a complete data set. Patients were stratified in two groups (3D-navigation (Group 3D-N) vs. control (Group F)) based on the imaging modality used. Primary outcomes were radiation exposure for patient and personnel. Secondary outcomes were reoperations, complications, and intraoperative precision.
Results: Of 392 patients screened, 174 patients (3D-N: n = 50, F: n = 124) could be included for final analysis. We noted a significant reduction of the dose corresponding to potential radiation exposure for medical personnel (-15.3 mGy, 95 %CI: -2.1 to -28.5, p = 0.0232), but also a significant increase of the dose quantifying radiation exposure for patients (+77.0 mGy, 95 %CI: +53.3 to +100.6, p < 0.0001), when using navigation. In addition, the rate of radiographic malplacement was significantly reduced (F: 11.3% vs. 3D-N: 0 %, p = 0.0113) despite a substantial increase in transsacral screw placement (F: 19.4% vs. 3D-N: 76 %).
Conclusion: Our data clearly suggests that the use of 3D-navigation for percutaneous SI screw fixation decreases radiation exposure for medical personnel, while increasing radiation exposure for patients. Furthermore, intraoperative precision is improved, even in more challenging operations.
Competing Interests: Declaration of Competing Interest All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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