Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
Arch Phys Med Rehabil. 2009 Dec;90(12):2112-5. doi: 10.1016/j.apmr.2009.08.137.
Diraçoğlu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.
To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA).
Experimental clinical study.
Operating theater of a university hospital.
Patients (N=16) (10 women, 6 men), who were diagnosed as having OA according to the American College of Rheumatology criteria and whose radiologic grades were II or III according to Kellgren-Lawrence.
Three bilateral and 13 unilateral hip injections were performed (3 times at 1-week intervals). After it was presumed blindly that the needle was within the joint, the location of the needle was checked with backflow technique and fluoroscopy. Entrance to the joint cavity was also ensured by reconfirmation with contrast medium, and the procedure was then terminated with hyaluronic acid injection.
Assessment of blind needle placement into the hip joint by using backflow technique, fluoroscopic images, and contrast enhancement.
The location of the needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%) of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38 interventions, localization of the intra-articular needle could be confirmed by intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions exhibited intra-articular contrast enhancement. Backflow was not observed in 23 (79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow.
In light of our results, we suggest that blind injection of the osteoarthritic hip joint can be inaccurate even with careful technique. Further, the backflow method does not appear to be reliable, and guidance during the injection seems to be necessary.
评估骨性关节炎患者行盲法/解剖参照髋关节腔内注射时的进针定位。
实验性临床研究。
一所大学医院的手术室。
符合美国风湿病学会标准诊断为骨性关节炎，根据 Kellgren-Lawrence 放射学分级为Ⅱ或Ⅲ级的患者 16 例（10 名女性，6 名男性）。
双侧髋关节各进行 3 次，单侧髋关节各进行 1 次共 16 次注射（每周 1 次，共 3 次）。盲法进针后，应用反流技术和透视检查确认针尖位置，再次应用对比剂确认针尖进入关节腔后结束操作，然后注入透明质酸钠。
应用反流技术、透视影像和对比增强来评估髋关节腔内盲法进针的情况。
在 57 次盲法操作中，38 次（66.7%）透视证实针尖位置恰当，29 次（76.3%）针尖位置可通过关节内对比剂显影来确认。57 次盲法操作中，29 次（50.9%）可见关节内对比剂显影。23 次（79.3%）未见反流，但 5 次（17.9%）未见对比剂显影的操作却出现了反流。
即使操作仔细，骨性关节炎患者行髋关节腔内盲法注射也可能不准确。另外，反流法似乎不可靠，在注射过程中需要有引导。
