透热和锯骨是高气溶胶产量的程序。

IF 4.7 2区 医学 Q2 CELL & TISSUE ENGINEERING Bone & Joint Research Pub Date : 2023-10-10 DOI:10.1302/2046-3758.1210.BJR-2023-0028.R1
Victoria Hamilton, Sadiyah Sheikh, Alicja Szczepanska, Nick Maskell, Fergus Hamilton, Jonathan P Reid, Bryan R Bzdek, James R D Murray
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摘要

目的:骨科手术使用多种高速、高冲击、热能的器械,有时还使用重型器械,所有这些都可能导致受污染的血液、组织和骨骼雾化,引起临床医生的健康问题。这项研究通过测量在关键整形外科手术中到达首席外科医生的颗粒的数量和大小分布来量化气溶胶暴露。方法:在主刀医师的位置,使用空气动力学粒子尺寸计(APS;直径为0.5至20μm的粒子)以1秒的时间分辨率采样,记录17例骨科开放手术(膝关节、髋关节和肩部)的气溶胶产量。通过时间戳,检测到的气溶胶归因于特定的程序。结果:透热(电烙术)和振荡骨锯的使用具有较高的气溶胶产量(每秒检测到>100个颗粒),与首席外科医生在可呼吸范围内(<5µm)的高暴露量一致。脉冲灌洗、扩孔、骨凿的使用和夹具的应用/去除是中等气溶胶产量(10-100个s-1颗粒)。然而,脉冲灌洗气溶胶在很大程度上归因于盐水射流,骨凿的使用时间总是很短,夹具的应用/移除在相关气溶胶产量方面具有很大的可变性。抽吸(有/没有盐水灌溉)的气溶胶产量较低(<10个颗粒s-1)。最令人惊讶的是,其他高速程序,如钻孔和拧螺丝,气溶胶产量很低。结论:这项工作建议对透热疗法和骨锯术采取额外的预防措施,如加强个人防护设备或使用抽吸装置以减少暴露。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Diathermy and bone sawing are high aerosol yield procedures.

Aims: Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians' health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.

Methods: The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.

Results: Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields.

Conclusion: This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.

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来源期刊
Bone & Joint Research
Bone & Joint Research CELL & TISSUE ENGINEERING-ORTHOPEDICS
CiteScore
7.40
自引率
23.90%
发文量
156
审稿时长
12 weeks
期刊介绍: The gold open access journal for the musculoskeletal sciences. Included in PubMed and available in PubMed Central.
期刊最新文献
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