RESUMO
We report on a new minimally invasive technique for the retrieval of a surgical pin fragment after accidental migration into the soft tissue of the shoulder in two patients. The technique is performed under local anaesthesia and uses combined CT and fluoroscopic guidance. The materials used were simple, combining a bone biopsy needle and an endoscopy clamp. Pin displacement was confirmed under fluoroscopic guidance and the clamp was used to withdraw the pin to the cutaneous entry point under CT (step-by-step) guidance. The CT slices provide perfect visualisation of the vascular or nervous structures as well as perfect positioning of the extremity of the trocar relative to the material to be removed. This intervention avoids a second surgical intervention with a longer incision and avoided repeated general anaesthesia.
Assuntos
Tecido Conjuntivo/diagnóstico por imagem , Tecido Conjuntivo/cirurgia , Fluoroscopia/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Tecido Conjuntivo/lesões , Humanos , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the performance of combined (computed tomography (CT) and fluoroscopic) guidance of balloon kyphoplasty in comparison to fluoroscopic guidance alone. MATERIALS AND METHODS: Forty-one kyphoplasties were performed between January 2005 and March 2006 according to two different protocols. Study group 1 consisted of 20 consecutive patients with 20 balloon kyphoplasty procedures under dual guidance (CT scan and fluoroscopy) for osteoporotic or traumatic vertebral fractures. Study group 2 consisted of 21 consecutive patients in whom kyphoplasty was performed with fluoroscopy alone. Visualization of the pedicles, the final of the balloon position, and cement distribution were evaluated(1-poor, 2-intermediate, 3-good). RESULTS: Combined use of CT and fluoroscopy (group 1) was superior in identifying the pedicles (100% versus 66.7%, p = 0.009) and balloon placement (100% versus 71.4%, p = 0.02) but not in monitoring of cement distribution within the vertebral body (100% versus 90.5%, p = 0.49). The difference between the two groups was more pronounced in the thoracic spine than in the lumbar spine. CONCLUSION: CT/fluoroscopic guidance of kyphoplasty combines safe CT-guided insertion of the osteointroducers and balloons as well as fluoroscopic real-time monitoring of polymethylmethacrylate injection.