Pichler W, Weinberg A M, Grechenig S, Tesch N P, Heidari N, Grechenig W
Department of Traumatology, Medical University of Graz, Graz, Austria.
J Bone Joint Surg Br. 2009 Dec;91(12):1638-40. doi: 10.1302/0301-620X.91B12.22740.
Intra-articular punctures and injections are performed routinely on patients with injuries to and chronic diseases of joints, to release an effusion or haemarthrosis, or to inject drugs. The purpose of this study was to investigate the accuracy of placement of the needle during this procedure. A total of 76 cadaver acromioclavicular joints were injected with a solution containing methyl blue and subsequently dissected to distinguish intra- from peri-articular injection. In order to assess the importance of experience in achieving accurate placement, half of the injections were performed by an inexperienced resident and half by a skilled specialist. The specialist injected a further 20 cadaver acromioclavicular joints with the aid of an image intensifier. The overall frequency of peri-articular injection was much higher than expected at 43% (33 of 76) overall, with 42% (16 of 38) by the specialist and 45% (17 of 38) by the resident. The specialist entered the joint in all 20 cases when using the image intensifier. Correct positioning of the needle in the joint should be facilitated by fluoroscopy, thereby guaranteeing an intra-articular injection.
对于关节损伤和慢性病患者，常规进行关节内穿刺和注射，以排出积液或关节积血，或注射药物。本研究的目的是调查该操作过程中针头放置的准确性。总共对76个尸体肩锁关节注射了含亚甲蓝的溶液，随后进行解剖以区分关节内注射和关节周围注射。为了评估经验在实现准确放置中的重要性，一半的注射由经验不足的住院医生进行，另一半由熟练的专家进行。专家借助影像增强器又对20个尸体肩锁关节进行了注射。关节周围注射的总体频率远高于预期，总体为43%（76例中的33例），专家注射的为42%（38例中的16例），住院医生注射的为45%（38例中的17例）。专家在使用影像增强器的所有20例中均进入了关节。荧光透视应有助于针头在关节内的正确定位，从而确保关节内注射。
