Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22908, USA.
AJR Am J Roentgenol. 2013 May;200(5):1096-100. doi: 10.2214/AJR.12.9227.
The purpose of this study was to evaluate the lateral mortise approach for performing therapeutic ankle injections.
Fluoroscopically guided ankle joint injections performed from November 2009 through June 2011 using the lateral ankle mortise approach were retrospectively reviewed. Data recorded included age, sex, fluoroscopic time, person performing the procedure, injection location, and preprocedure and postprocedure pain levels. Radiographs were reviewed for arthritis on a modified Kellgren-Lawrence scale, and the degree of anterior tibiotalar and lateral mortise narrowing was graded from none to severe. Univariate and multivariate statistical analyses were performed.
Fifty-three injections were performed on 46 patients (mean age, 50.2 years; mean fluoroscopic time, 44.3 ± 47.3 seconds). Fifty injections in 44 patients were successful with the lateral mortise approach. The degrees of arthritis and anterior tibiotalar joint narrowing were moderate in 22.6% and 20.8% of cases and severe in 39.6% and 32.1% of cases. Lateral mortise narrowing was moderate in 9.4% and severe in 1.9% of cases. Average pre-procedure and postprocedure pain levels were 5.3/10 ± 2.4/10 and 1.7/10 ± 2.3/10. Multivariate analysis showed that increased fluoroscopic time was associated with moderate to severe lateral mortise narrowing (p = 0.011) but that arthritis score (p = 0.811) and degree of anterior tibiotalar joint narrowing (p = 0.416) were not. Pain reduction was associated with a higher preinjection pain score (p ≤ 0.001).
The lateral mortise approach is an effective alternative to the anterior medial approach for performing therapeutic ankle injections. It is especially useful when moderate to severe ankle arthritis or anterior tibiotalar joint narrowing is present.
本研究旨在评估经外侧踝窝入路进行治疗性踝关节注射的效果。
回顾性分析 2009 年 11 月至 2011 年 6 月期间，采用经外侧踝窝入路行关节造影引导下踝关节注射的患者资料。记录的资料包括年龄、性别、透视时间、操作医生、注射部位、术前和术后疼痛程度。根据改良 Kellgren-Lawrence 分级评估关节炎，对距骨与胫骨前侧和外侧窝间隙变窄程度进行分级（从无到严重）。采用单变量和多变量统计分析。
46 例患者共进行了 53 次注射（平均年龄 50.2 岁，平均透视时间 44.3±47.3 秒）。44 例患者中有 50 次注射采用外侧踝窝入路成功。22.6%和 20.8%的病例关节炎和距骨与胫骨前侧关节狭窄程度为中度，39.6%和 32.1%的病例为重度。9.4%和 1.9%的病例外侧踝窝狭窄程度为中度和重度。平均术前和术后疼痛评分为 5.3/10±2.4/10 和 1.7/10±2.3/10。多变量分析显示，透视时间延长与中重度外侧踝窝狭窄有关（p=0.011），但与关节炎评分（p=0.811）和距骨与胫骨前侧关节狭窄程度（p=0.416）无关。疼痛缓解与术前疼痛评分较高有关（p≤0.001）。
与经前内侧入路相比，外侧踝窝入路是进行治疗性踝关节注射的有效替代方法。在存在中重度踝关节关节炎或距骨与胫骨前侧关节狭窄时尤其有用。
