Department of Anesthesia and Pain Medicine, University of Washington, Seattle, WA 98195, USA.
Reg Anesth Pain Med. 2012 Mar-Apr;37(2):228-31. doi: 10.1097/AAP.0b013e3182461144.
Diagnostic and therapeutic injections of the zygapophyseal joint (z-joint) are routinely performed under radiologic guidance (eg, fluoroscopy, computed tomography). Technically, these procedures could also be completed using ultrasound guidance, but existing evidence insufficiently supports this alternative imaging method, and it cannot therefore be recommended as a standard practice. There has also been no published proof-of-concept study using a routine fluoroscopy control for ultrasound-guided z-joint injections.
A cadaver study was performed to validate ultrasound as an imaging modality for z-joint injections. Fifty z-joint injections were performed on 5 nonembalmed specimens. In-plane ultrasound approach was implemented. Zygapophyseal joints were accessed through a needle placement under the joint capsule into the posterior synovial recess. Iohexol was thereby injected, and fluoroscopy was subsequently performed.
In 44 (88%) of 50 performed injections, the intra-articular spread of the contrast agent was clearly observed on the fluoroscopy image. In 6 (12%) of 50 cases, the contrast flow appeared in the soft tissues. In 4 of the 6 failed injections, the z-joint gap was not evident on an ultrasound image. No intravascular, nerve root, or epidural injections were observed.
Ultrasound may be a viable alternative to fluoroscopy or computed tomography as a guidance method for lumbar z-joint injections.
关节突关节（z 关节）的诊断和治疗性注射通常在放射学引导下（例如透视、计算机断层扫描）进行。从技术上讲，这些程序也可以使用超声引导来完成，但现有证据不足以支持这种替代成像方法，因此不能将其推荐为标准实践。也没有使用常规透视对照的超声引导 z 关节注射的已发表概念验证研究。
进行了一项尸体研究，以验证超声作为 z 关节注射的成像方式。在 5 个非防腐标本上进行了 50 次 z 关节注射。实施了平面内超声方法。关节突关节通过关节囊下的针放置进入后滑膜隐窝进行穿刺。随后注入碘海醇，并进行透视检查。
在 50 次注射中的 44 次（88%）中，在透视图像上清楚地观察到造影剂的关节内扩散。在 50 例中的 6 例（12%）中，造影剂在软组织中出现。在 6 次失败的注射中，有 4 次未能在超声图像上显示 z 关节间隙。未观察到血管内、神经根或硬膜外注射。
超声可能是透视或计算机断层扫描作为腰椎 z 关节注射引导方法的可行替代方法。
