Stulc Steven M, Hurdle Mark F B, Pingree Matthew J, Brault Jeffrey S, Porter Christopher A
Departments of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
J Ultrasound Med. 2011 Mar;30(3):357-62. doi: 10.7863/jum.2011.30.3.357.
The purpose of this study was to describe a technique using ultrasound guidance to perform thoracic facet joint injections.
A single examiner used ultrasound to localize paired thoracic facet joints from T1-2 through T10-11 on a fresh frozen cadaveric specimen. This was done using a 2- to 5-MHz curvilinear transducer over the target facet in the sagittal plain with the cadaver in the prone position. Target facets were identified using the most inferior rib as a starting point and scanning medially toward its axial attachment and further medially and slightly superior over the most caudal thoracic facet (T11-12). Subsequent ipsilateral facet joints were identified by simply moving the transducer superiorly in the sagittal plain until the next cephalad facet was encountered. After identification, injections were performed using a long-axis or "in-line" approach with continual visualization of the needle into each facet joint. After needle placement, computed images were obtained from a fluoroscopy machine capable of 3-dimensional reconstruction to assess the location of the needle tips. After this, 0.5 mL of an iodinated contrast agent was injected, and another 3-dimensional reconstruction was performed to assess the location of the injected agent. A senior radiology resident reviewed the computed images in coronal, axial, and sagittal planes. Accuracy was determined in terms of contrast location, graded as either intra-articular or extra-articular.
Sixteen (80%) of 20 injections performed showed intra-articular contrast spread.
We describe a relatively feasible technique for performing thoracic facet joint injections using ultrasound guidance. Further verification of this technique, and modification if applicable, should be performed before directly applying this technique in a clinical practice setting.
本研究旨在描述一种使用超声引导进行胸椎小关节注射的技术。
一名检查者在一具新鲜冷冻的尸体标本上，使用超声从T1-2至T10-11定位成对的胸椎小关节。尸体处于俯卧位，在矢状面使用2至5兆赫的曲线换能器在目标小关节上方进行操作。以最下方的肋骨为起点，向其轴向附着点内侧扫描，并在最尾侧的胸椎小关节（T11-12）上方进一步向内侧并稍向上方扫描，以识别目标小关节。随后，通过在矢状面简单地将换能器向上移动，直到遇到下一个头侧小关节，来识别同侧的后续小关节。识别后，采用长轴或“直线”方法进行注射，同时持续观察针头进入每个小关节。针头放置后，从能够进行三维重建的荧光透视机获取计算机图像，以评估针尖的位置。在此之后，注射0.5毫升碘化造影剂，并再次进行三维重建以评估注射剂的位置。一名资深放射科住院医师在冠状面、轴位和矢状面查看计算机图像。根据造影剂的位置确定准确性，分为关节内或关节外。
20次注射中有16次（80%）显示造影剂在关节内扩散。
我们描述了一种使用超声引导进行胸椎小关节注射的相对可行的技术。在将该技术直接应用于临床实践之前，应进一步验证该技术，并在适用时进行改进。
