Validity of preoperative ultrasound-guided aspiration in the revision of hip prosthesis

Preoperative diagnosis of septic loosening hip prosthesis is often challenging. Culture test on joint samples obtained during revision surgery is the diagnostic gold standard while the role of preoperative hip aspiration is still controversial. The aims of this prospective randomized study were to compare the sensitivity, specificity and accuracy of preoperative ultrasound-guided and fluoroscopic-guided aspiration, and to identify associated laboratory parameters or scintigraphy that could help in predicting septic loosing hip prosthesis. Sixty patients affected by persistent pain after hip prosthesis randomly received fluoroscopic-guided or ultrasound-guided hip aspiration before revision surgery. The results of culture tests of joint fluid presurgically and at surgery were compared. In addition, associated blood inflammatory markers and scintigraphy were evaluated. Ultrasound-guided aspiration showed a better sensitivity (69% vs. 27%), specificity (94% vs. 75%) and accuracy (83% vs. 40%) than fluoroscopic-guided aspiration. The combination of ultrasound-guided aspiration and C-reactive protein represents the best model to predict septic loosening hip prosthesis preoperatively.     

X线监视下经皮穿刺活检胸腰椎椎体病灶145例分析

目的 探讨X线监视下经皮穿刺活检胸腰椎椎体病灶,分析其在脊柱疾患诊断中的作用与意义.方法 145例脊柱椎体病灶患者,胸椎87例,腰椎58例,其中单一椎体94例,多发椎体51例.为明确病理诊断,常规行X线监视下(C型臂或G型臂)穿刺活检,使用骨穿刺针(意大利Gallini S.R.L公司).结果 本组145例,其中141例穿刺成功,4例中途放弃或穿刺失败.穿刺用时10-45min,平均20min.穿刺标本送检后,获得明确病理学诊断130例,阳性率为89.7%.结论 X线监视下穿刺活检是胸腰椎椎体病变明确诊断的安全、有效方法.     

X线引导下选择性颈神经根阻滞在神经根型颈椎病诊疗中的应用及评价

目的 探讨X线引导下选择性颈神经根阻滞（selective nerve root blocks, SNRBs）在神经根型颈椎病诊疗中应用的安全性及价值。方法 回顾性分析2014年3月至2019年2月我院收治并行X线引导下SNRBs进行神经根型颈椎病诊断与治疗的病人67例，其中52例诊断为神经根型颈椎病病人接受神经根阻滞治疗，15例经阻滞确诊为神经根型颈椎病或确定责任节段并接受治疗。记录所有病人临床资料、影像学资料、操作是否成功、手术时间、术中并发症发生情况、术前和术后各随访时间点疼痛视觉模拟量表（visual analogue scale, VAS）评分及颈椎功能障碍指数（neck disability index, NDI）。结果 所有病人均操作成功，2例病人分别出现上肢乏力和头晕，于术后6 h和4 h后恢复；病人阻滞后即时、3个月及末次随访时VAS评分及NDI评分均较阻滞前有所降低，差异均具有统计学意义（P均＜0.05）。末次随访时，63例病人症状均获得明显缓解，获得满意保守治疗效果；4例病人后转行手术治疗。结论 X线引导下SNRBs操作简单、安全，可用于辅助诊断神经根型颈椎病，确认责任节段；并可作为神经根型颈椎病的一种有效的治疗方式。     

Fluoroscopy-Guided Pull-Through Gastrostomy

The purpose of this study was to simplify a fluoroscopy guided gastrostomy technique using pull-type tubes which are traditionally introduced with gastroscopic assistance. The stomach was transorally probed with a 5-Fr catheter and a guidewire. A second access was performed percutaneously through the anterior abdominal and gastric wall using an 8-Fr sheath and an 8-Fr guiding catheter. A duplicated guidewire was introduced through the guiding catheter in order to result in a great custom-made loop within the stomach. The transoral guidewire was captured and tightened with this loop and the guiding catheter, and both were subsequently pulled by the transoral guidewire until the tip of the guiding catheter exited the mouth. A thread was fed through the guiding catheter for fixation of the pull-type gastrostomy tube. Finally, the fixed tube was pulled through the esophagus into the stomach and through the abdominal wall until the anterior gastric wall fixed the retention plate of the tube. Thirty-seven patients (28 male, 9 female; age, 65.1 ± 14.4 years) with miscellaneous indications for percutaneous gastrostomies were supplied with pull-type gastrostomy catheters in a fluoroscopy technique without endoscopic assistance. Twenty-five of the 37 patients (67.6%) had undergone unsuccessful preceding gastroscopically guided PEG attempts because of tumor stenosis (n = 12) or impossible transillumination of the abdominal wall (n = 13). All procedures were technically successful, without major complications. Particularly, all patients with frustrating gastroscopic attempts were successfully provided with pull-type gastrostomy tubes. Five minor complications occurred: one tube loss during the passage of the hypopoharynx because of a torn thread, one transient small leakage alongside the tube (both successfully treated), and three cases of transient moderate local pain without leakage (symptomatic treatment). We conclude that this fluoroscopy-guided pull-through gastrostomy technique is easy and safe to perform and may be suggested as a standard procedure for radiological gastrostomies. It combines the ease of the radiological approach with the advantages of the pull-type tube devices, particularly the benefits of the typical retention plates.     

Reduction of radiation dose during facet joint injection using the new image guidance system SabreSource™: a prospective study in 60 patients

Interventional procedures are associated with high radiation doses for both patients and surgeons. To reduce the risk from ionizing radiation, it is essential to minimize radiation dose. This prospective study was performed to evaluate the effectiveness in reducing radiation dose during facet joint injection in the lumbar spine and to evaluate the feasibility and possibilities of the new real time image guidance system SabreSource™. A total of 60 patients, treated with a standardized injection therapy of the facet joints L4–L5 or L5–S1, were included in this study. A total of 30 patients were treated by fluoroscopy guidance alone, the following 30 patients were treated using the new SabreSource™ system. Thus a total of 120 injections to the facet joints were performed. Pain, according to the visual analogue scale (VAS), was documented before and 6 h after the intervention. Radiation dose, time of radiation and the number of exposures needed to place the needle were recorded. No significant differences concerning age (mean age 60.5 years, range 51–69), body mass index (mean BMI 26.2, range 22.2–29.9) and preoperative pain (VAS 7.9, range 6–10) were found between the two groups. There was no difference in pain reduction between the two groups (60 vs. 61.5%; P = 0.001) but the radiation dose was significantly smaller with the new SabreSource™ system (reduction of radiation dose 32.7%, P = 0.01; reduction of mean entrance surface dose 32.3%, P = 0.01). The SabreSource™ System significantly reduced the radiation dose received during the injection therapy of the lumbar facet joints. With minimal effort for the setup at the beginning of a session, the system is easy to handle and can be helpful for other injection therapies (e.g. nerve root block therapies).