Jackson Douglas W, Evans Nicholas A, Thomas Bradley M
Southern California Center for Sports Medicine, Long Beach 90806, USA.
J Bone Joint Surg Am. 2002 Sep;84(9):1522-7. doi: 10.2106/00004623-200209000-00003.
To achieve their potential therapeutic benefit, hyaluronic acid derivatives should be injected directly into the knee joint space and not into the anterior fat pad or the subsynovial tissues. In the absence of a knee effusion, reproducible needle placement into the intra-articular space presents a challenge to the clinician.
The accuracy of needle placement was assessed in a prospective series of 240 consecutive injections in patients without clinical knee effusion. The injections were performed by one orthopaedic surgeon using a 2.0-in (5.1-cm) 21-gauge needle through three commonly employed knee joint portals: anteromedial, anterolateral, and lateral midpatellar. Accuracy rates for needle placement were confirmed with fluoroscopic imaging to document the dispersion pattern of injected contrast material.
Of eighty injections performed through an anterolateral portal, fifty-seven were confirmed to have been placed in the intra-articular space on the first attempt (an accuracy rate of 71%). Sixty of eighty injections performed through an anteromedial approach were intra-articular on the first attempt (75% accuracy rate), as were seventy-four of eighty injections performed through a lateral midpatellar portal (93% accuracy rate).
Using real-time fluoroscopic imaging with contrast material, we demonstrated the difficulty of accurately placing a needle into the intra-articular space of the knee when an effusion is not present. This study revealed that a lateral midpatellar injection (an injection into the patellofemoral joint) was intra-articular 93% of the time and was more accurate than injections performed by the same orthopaedic surgeon using either of the other two portals. This study highlights the need for clinicians to refine injection techniques for delivering intra-articular therapeutic substances that are intended to coat the articular surfaces of the knee joint.
为实现其潜在的治疗益处，透明质酸衍生物应直接注射到膝关节间隙，而非前脂肪垫或滑膜下组织。在没有膝关节积液的情况下，将针头可重复地放置到关节腔内对临床医生来说是一项挑战。
在一系列前瞻性研究中，对240例无临床膝关节积液的患者进行连续注射，评估针头放置的准确性。注射由一名骨科医生使用2.0英寸（5.1厘米）21号针头，通过三个常用的膝关节入口进行：前内侧、前外侧和髌骨外侧中点。通过透视成像确认针头放置的准确率，以记录注射造影剂的弥散模式。
通过前外侧入口进行的80次注射中，57次在首次尝试时被确认放置在关节腔内（准确率为71%）。通过前内侧入路进行的80次注射中有60次首次尝试时进入关节内（准确率75%），通过髌骨外侧中点入口进行的80次注射中有74次也是如此（准确率93%）。
使用含造影剂的实时透视成像，我们证明了在没有积液的情况下，将针头准确放置到膝关节腔内存在困难。这项研究表明，髌骨外侧中点注射（注入髌股关节）93%的情况下进入关节内，并且比同一名骨科医生使用其他两个入口进行的注射更准确。这项研究强调临床医生需要改进注射技术，以递送旨在覆盖膝关节关节面的关节内治疗物质。
