Department of Internal Medicine, Division of Rheumatology, MSC10-5550 5th FL ACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
J Rheumatol. 2011 Feb;38(2):252-63. doi: 10.3899/jrheum.100866. Epub 2010 Nov 15.
We studied whether sonographic needle guidance affected the outcomes of intraarticular (IA) injection for inflammatory arthritis.
Joints with inflammatory arthritis (n = 244; 76% rheumatoid arthritis, 3% small joints, 51% intermediate, and 46% large) were randomized to injection by conventional palpation-guided anatomic injection (120 joints) or sonographic image-guided injection enhanced with a 1-handed reciprocating procedure device mechanical syringe (124 joints). A 1-needle, 2-syringe technique was used. After IA placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and triamcinolone acetonide was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined.
Relative to conventional palpation-guided methods, sonographic guidance for injection of inflammatory arthritis resulted in an 81% reduction in injection pain (p < 0.001), 35% reduction in pain scores at outcome (p < 0.02), 38% increase in the responder rate (p < 0.003), 34% reduction in the non-responder rate (p < 0.003), 32% increase in therapeutic duration (p = 0.01), 8% reduction ($7) in cost/patient/year, and a 33% ($64) reduction in cost/responder/year for a hospital outpatient (p < 0.001).
Sonographic needle guidance improves the performance, clinical outcomes, and cost-effectiveness of IA injections for inflammatory arthritis. (Clinical Trial Identifier NCT00651625).
我们研究了超声引导下的关节内（IA）注射是否会影响炎性关节炎的治疗效果。
将患有炎性关节炎的关节（n=244；76%为类风湿关节炎，3%为小关节，51%为中等关节，46%为大关节）随机分为两组：经传统触诊引导下的解剖注射（120 个关节）或超声图像引导下注射，同时使用单手往复操作装置的机械注射器进行增强（124 个关节）。采用 1 针 2 注射器技术。IA 位置确定并通过超声确认关节滑膜腔扩张后，进行注射器更换，通过留置的 IA 针，用第二注射器注入曲安奈德。测定基线疼痛、操作过程疼痛、结局时疼痛（2 周和 6 个月）、应答者、治疗持续时间、再次注射率、总费用和每应答者的成本。
与传统触诊引导方法相比，超声引导炎性关节炎注射可使注射疼痛降低 81%（p<0.001），结局时疼痛评分降低 35%（p<0.02），应答率提高 38%（p<0.003），无应答率降低 34%（p<0.003），治疗持续时间延长 32%（p=0.01），每位患者/年的成本降低 8%（$7），医院门诊每位应答者/年的成本降低 33%（$64）（p<0.001）。
超声引导下的针头引导提高了 IA 注射治疗炎性关节炎的性能、临床效果和成本效益。（临床试验标识符 NCT00651625）。
