Schumacher J, Livesey L, Brawner W, Taintor J, Pinto N
Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA.
Equine Vet J. 2007 Jul;39(4):356-9. doi: 10.2746/042516407x174324.
Centesis of the bicipital bursa using an 8.9 cm long spinal needle has been reported but the alternative of employing a 3.8 cm long hypodermic needle requires validation.
To compare the efficacy of 2 different methods of centesis of the bicipital bursa and to evaluate the usefulness of ultrasonographic imaging to determine the location of solution administered when centesis of the bursa is attempted.
For Trial 1, 6 clinicians, who had no previous experience of centesis of the bicipital bursa, attempted to inject a solution composed of an aqueous radiopaque contrast medium and physiological saline solution (PSS) into the bicipital bursae of 2/12 horses using the previously described distal approach to inject one bursa and a proximal approach to inject the contralateral bursa. The bicipital tendon and bursa were examined ultrasonographically before and after injection; and both shoulders were examined radiographically to identify the location of the medium. In Trial 2, another 6 clinicians, also with no previous experience of centesis, repeated Trial 1, using 6 horses, but the radiopaque contrast medium was mixed with air instead of PSS.
Accuracy of centesis using the proximal approach was 39% and that of the distal approach 28%. Ultrasonographic examination of the shoulder allowed the location of solution and air to be accurately predicted in all 12 shoulders examined.
Clinicians who have had no previous experience performing centesis of the bicipital bursa are unlikely to be successful in centesis using either approach. Radiographic examination after injecting a radiopaque contrast medium may be necessary to assess the success of centesis especially if bursal fluid is not obtained during centesis. Injecting air along with the radiopaque contrast medium provides more accurate ultrasonographic confirmation of centesis and better radiographic definition than does injection without air.
已有报道使用8.9厘米长的脊椎穿刺针进行肱二头肌滑囊穿刺，但采用3.8厘米长的皮下注射针这一替代方法需要验证。
比较两种不同的肱二头肌滑囊穿刺方法的疗效，并评估超声成像在尝试进行滑囊穿刺时确定注入溶液位置的实用性。
在试验1中，6名此前没有肱二头肌滑囊穿刺经验的临床医生，尝试使用先前描述的远端入路向12匹马中的2匹马的一侧肱二头肌滑囊注入由水溶性不透射线造影剂和生理盐水（PSS）组成的溶液，向对侧肱二头肌滑囊采用近端入路注入溶液。在注射前后对肱二头肌肌腱和滑囊进行超声检查；并对双侧肩部进行X线检查以确定造影剂的位置。在试验2中，另外6名同样没有穿刺经验的临床医生，对6匹马重复试验1，但不透射线造影剂与空气混合而非与PSS混合。
采用近端入路穿刺的准确率为39%，远端入路为28%。对肩部进行超声检查能准确预测所有12个被检查肩部中溶液和空气的位置。
此前没有肱二头肌滑囊穿刺经验的临床医生，无论采用哪种入路进行穿刺都不太可能成功。尤其是在穿刺过程中未获取到滑囊液时，注射不透射线造影剂后进行X线检查可能对于评估穿刺是否成功是必要的。与不注入空气相比，将空气与不透射线造影剂一起注入能提供更准确的超声穿刺确认以及更好的X线显影。
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