Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
J Clin Rheumatol. 2011 Dec;17(8):409-15. doi: 10.1097/RHU.0b013e31823a49a4.
The present randomized controlled study investigated whether sonographic needle guidance affected the outcomes of intra-articular injection for osteoarthritis of the knee.
Ninety-four noneffusive knees with osteoarthritis were randomized to injection by conventional palpation-guided anatomic landmark injection or sonographic image-guided injection enhanced with a 1-handed mechanical (the reciprocating procedure device) syringe. After intra-articular placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected with the second syringe through the indwelling intra-articular 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 anatomic landmark methods, sonographic guidance for injection of the knee resulted in 48% reduction in procedural pain (P < 0.001), a 42% reduction in pain scores at outcome (P < 0.03), 107% increase in the responder rate (P < 0.001), 52% reduction in the nonresponder rate (P < 0.001), a 36% increase in therapeutic duration (P = 0.01), a 13% reduction ($17) in cost per patient per year, and a 58% ($224) reduction in cost per responder per year for a hospital outpatient (P < 0.001).
Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.
本随机对照研究旨在探讨超声引导下经皮穿刺是否会影响膝关节骨关节炎关节内注射的效果。
94 例膝关节非渗出性骨关节炎患者随机分为经传统触诊引导解剖标志入路注射组或超声图像引导联合单手机械（往复程序装置）注射器注射组。超声确认关节内位置和滑膜腔扩张后，进行注射器交换，用第二支注射器通过留置的关节内针注射 80mg 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、总费用和每个应答者的费用。
与传统触诊引导解剖标志方法相比，膝关节超声引导注射可使操作过程疼痛降低 48%（P<0.001），结局时疼痛评分降低 42%（P<0.03），应答率提高 107%（P<0.001），无应答率降低 52%（P<0.001），治疗持续时间延长 36%（P=0.01），每位患者每年的人均治疗费用降低 13%（$17），每位应答者每年的人均治疗费用降低 58%（$224），用于医院门诊患者（P<0.001）。
超声引导下经皮穿刺可减轻操作过程中的疼痛，改善膝关节骨关节炎关节内注射的临床效果和成本效益。
