Gruson Konrad I, Ruchelsman David E, Zuckerman Joseph D
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY 10003, USA.
J Shoulder Elbow Surg. 2008 Jan-Feb;17(1 Suppl):118S-130S. doi: 10.1016/j.jse.2007.07.009.
The use of subacromial injections to treat shoulder pain has remained one of the most common procedures for the practicing orthopedist, rheumatologist, and general practitioner. Despite this, many prospective studies have questioned the efficacy of corticosteroid injections compared with nonsteroidal anti-inflammatory drugs or injections of local anesthetics alone, or both, when used for the treatment of symptomatic rotator cuff disease. Accurate diagnosis of the etiology of a patient's shoulder pain and proper injection technique are important in achieving satisfactory clinical outcomes. Both extrinsic as well as intrinsic etiologies for rotator cuff disease should be considered and must be elucidated with appropriate physical examination techniques. Although subacromial injections appear straightforward, more recent cadaveric, radiographic, and clinical studies have demonstrated variable accuracy rates using the two common techniques. In addition, absolute sterile technique must be used because infections of the subacromial space after injections, although uncommon, have generally led to debilitating conditions. This article reviews the etiology and pathophysiology of rotator cuff disease and the indications and techniques for subacromial corticosteroid injections.
对于执业骨科医生、风湿病学家和全科医生而言，使用肩峰下注射治疗肩部疼痛一直是最常见的操作之一。尽管如此，许多前瞻性研究对皮质类固醇注射与非甾体抗炎药或单独注射局部麻醉剂或两者联合使用治疗有症状的肩袖疾病的疗效提出了质疑。准确诊断患者肩部疼痛的病因并采用恰当的注射技术对于取得满意的临床效果至关重要。肩袖疾病的外在和内在病因均应予以考虑，且必须通过适当的体格检查技术加以阐明。尽管肩峰下注射看似简单，但最近的尸体解剖、影像学和临床研究表明，两种常用技术的准确率各不相同。此外，必须采用绝对无菌技术，因为注射后肩峰下间隙感染虽然不常见，但通常会导致使人衰弱的病症。本文综述了肩袖疾病的病因和病理生理学，以及肩峰下皮质类固醇注射的适应证和技术。
