Yamakado Kotaro
Department of Orthopaedics, Kahoku Central Hospital, Japan.
Arthroscopy. 2002 Oct;18(8):887-91. doi: 10.1053/jars.2002.35263.
The study goal was to examine the targeting accuracy of subacromial injection to the shoulder and the influence of the location of the injected structure.
A prospective nonrandomized study.
Fifty-three patients (56 shoulders; 34 women and 19 men; mean age, 74.5 years; range, 49 to 91) with impingement signs (Neer, Hawkins) of at least 2 months' duration received a subacromial injection of a mixture of 0.5 mL (2.5 mg) betamethasone acetate and 3 mL of radiographic contrast material (iotrolan) and 7 mL of 1% lidocaine using a lateral approach. Radiographs of the shoulder joint were taken immediately after the injection to determine the structure reached by the injection. Details of pain expressed as Neer and Hawkins impingement signs were obtained before and 15 minutes after the injection, and subjectively assessed using a 4-point self-administered pain score. Pain reduction resulting from subacromial and intradeltoid injection was compared.
Thirty-nine of the 56 injections (70%) were judged to have reached the subacromial bursa. Twelve (21%) were seen to have entered the deltoid muscle; 2 (4%) were in the glenohumeral joint; and 3 (5%) were subcutaneous. A comparison of subacromial bursal with intradeltoid injection showed no significant differences in pain reduction expressed as impingement signs (1.5 vs 1.7 in the Neer impingement sign and 1.6 vs 1.6 in the Hawkins impingement sign, respectively).
This study showed that subacromial injection was a relatively difficult procedure. A high incidence of injections that missed the subacromial bursa would be a sufficient reason to refrain from repeated usage of corticosteroids. These results also suggest that pain relief could be attained whether the injected material reached the subacromial bursa or the deltoid muscle. Successful pain relief after intradeltoid injection seems to call into question the diagnostic value of a positive Neer impingement test.
本研究的目标是检查肩峰下注射至肩部的靶向准确性以及注射结构位置的影响。
前瞻性非随机研究。
53例患者（56个肩部；34名女性和19名男性；平均年龄74.5岁；范围49至91岁），有至少2个月持续时间的撞击征（Neer征、Hawkins征），采用外侧入路接受肩峰下注射0.5 mL（2.5 mg）醋酸倍他米松、3 mL放射造影剂（碘曲仑）和7 mL 1%利多卡因的混合液。注射后立即拍摄肩关节X线片以确定注射所到达的结构。在注射前和注射后15分钟获取以Neer和Hawkins撞击征表示的疼痛细节，并使用4分自我评估疼痛评分进行主观评估。比较肩峰下注射和三角肌内注射导致的疼痛减轻情况。
56次注射中有39次（70%）被判定到达肩峰下滑囊。12次（21%）进入三角肌；2次（4%）进入盂肱关节；3次（5%）位于皮下。肩峰下滑囊注射与三角肌内注射相比，以撞击征表示的疼痛减轻情况无显著差异（Neer撞击征分别为1.5对1.7，Hawkins撞击征分别为1.6对1.6）。
本研究表明肩峰下注射是一个相对困难的操作。错过肩峰下滑囊的注射发生率较高，这足以成为避免重复使用皮质类固醇的充分理由。这些结果还表明，无论注射材料是否到达肩峰下滑囊或三角肌，都可以实现疼痛缓解。三角肌内注射后成功缓解疼痛似乎对Neer撞击试验阳性的诊断价值提出了质疑。
