Two Simple Tests for Adequate Needle Positioning in Vertebroplasty / 대한척추외과학회지

STUDY DESIGN: We analyzed the diagnostic values of two simple tests for adequate needle positioning in vertebroplasty. OBJECTIVES: We wanted to suggest performing the aspiration test and patency test, which can replace some of the roles of intraosseous venography (IOV) in vertebroplasty, and we also wanted to analyze the two tests' diagnostic values. SUMMARY OF LITERATURE REVIEW: Intra-osseous venography is an existing safety test for vertebroplasty, but it is less frequently performed nowadays because of its drawbacks. MATERIALS AND METHODS: The aspiration test is defined as positive if blood is easily aspirated through a vertebroplasty needle, and a positive aspiration test means that the needle tip is communicating with the venous system. This and IOV were carried out on a total of 114 sides of 61 vertebrae of 40 consecutive patients. Agreement between the two tests was evaluated with using Cohen's kappa coefficient, and the diagnostic values of the aspiration test, with using IOV as the gold standard, were also evaluated. The patency test is done in the intra-vertebral vacuum cleft cases. After bipedicular insertion of needles, saline is injected into one needle. If the saline gushes out of the other needle, the test is positive, and it means that both needles are inserted in the vacuum cleft. The patency test was performed in 25 vertebrae, and the positive rate and causes of the negative result were investigated. RESULTS: Cohen's kappa coefficient between the aspiration test and IOV was 0.88. The sensitivity of the aspiration test was 88%, the specificity was 99%, the positive predictive value was 97%, and the negative predictive value was 93%. The patency test was positive in 88% of the vacuum clefts. In all the positive cases, both needles were located within the vacuum cleft. In all the negative cases, one of the two needles was located outside the cleft. CONCLUSIONS: The aspiration test is a simple and reliable test that has high agreement with IOV. The patency test can be a better choice than IOV for the vacuum cleft cases because it does not leave contrast media in the clefts.

The Changes of the Intra-Osseous Venographic Findings of the Proximal Femur before and after Intertrochanteric Varus Osteotomy in Legg-Calve-Perthes' Disease: Comparision of Venographic Changes between Normal and Affected Hip / 대한정형외과학회잡지

In order to clarify the changes of the venous circulation in normal and affected hip with Legg-Ca1ve-Perthes' disease(L.C.P.D.) and to assess the effect of intertrochanteric varus osteotomy on the venous circulation around the proximal femur in L.C.P.D., intra-osseous venography(I.O.V.) was performed before osteotomy and also 8 weeks later when K-wires or staples used at the time of osteotomy were removed. Results obtained were as follows: 1. The material was consisted of 13 normal and 17 hips with L.C.P.D.. There were 14 boys and one girl, with a mean age of 6.1 years ranged from 5 to 9 years; in two patients the disease was bilateral. 2. When the hips with L.C.P.D. were divided into four groups by the method described by Catterall, three hips were included in group II, ten in III and four in IV. 3. In I.O.V. of the proximal femoral metaphysis on 13 normal hips, the opaque medium disappeard rapidly through the local venous system around the proximal femur, and no regurgitation into diaphysis were noted. But gluteal and medial circumflex vein in each one case was not visualized. 4. Of 17 hips with L.C.P.D., an I.O.V. was carried out before and after the intertrochanteric osteotomy. The ligamentum teres and gluteal vein appeared in only 4(24%) and 7 hips (41%) before and after osteotomy. And the lateral and medial circumflex vein visualized in 12(71%) and 15 hips before osteotomy and in 17 hips, both after osteotomy. The diaphyesal regurgitation in 35 % and trochanteric venous pooling of the opaque medium in 47%, indicating venous congestion on the trochanteric region of femur, disappeared after the osteotomy. But no significant differences in their age and group of L.C.P.D. were found. All of these findings suggest that the impaired venous system around the proximal femur and increased intra-osseous pressure on proximal femur may act as one of the important role in pathophysiology of the L.C.P.D., and the intertrochanteric osteotomy might have some positive effect for the normalization of venous circulation and intra-osseous pressure in L.C.P.D..