Nam Sang Hyun, Kim Jongwoo, Lee Ji Hae, Ahn Jaeki, Kim Young Joo, Park Yongbum
Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
Clin Rheumatol. 2014 Dec;33(12):1807-14. doi: 10.1007/s10067-013-2355-7. Epub 2013 Aug 11.
The aim of this study was to conduct a randomized, prospective single-blinded clinical study on the mid-term benefits and accuracy rate of the ultrasound (US)-guided versus palpation-guided intra-articular (IA) injections for the treatment of distal radioulnar joint (DRUJ) disorder. Subjects with DRUJ disorder (n = 60) were randomly assigned to undergo US-guided or palpation-guided IA injection. Primary outcomes were measured with Disability of the Arm, Shoulder, and Hand questionnaire (DASH) and secondary outcomes included Verbal Numeric Pain Scale (VNS), Modified Mayo Wrist Score (MMWS), range of motion (ROM), and accuracy rate between two groups; 1.25 mL of mixed material (0.5 ml Omnipaque + 1 % lidocaine 0.25 ml + triamcinolone 20 mg 0.5 ml) was injected into the intra-articular space of the DRUJ. Treatment effects were assessed by using VNS, DASH, MMWS, and passive ROM of the DRUJ (supination, pronation from neutral) before the injections and at 1, 3, and 6 months after the injections. After the US-guided and palpation-guided IA injection into DRUJ, a radiographic image was taken to determine whether the injected material had reached the IA space or infiltrated into the soft tissue. US-guided IA injections showed significantly higher accuracy (100 %) than palpation-guided IA injections (75.8 %) in DRUJ. VNS, DASH, MMWS, and ROM were improved at 1, 3, and 6 months in both groups. There was no significant difference in clinical outcomes between the group receiving US-guided injections and the group receiving palpation-guided injections. US-guided IA injection showed significantly higher accuracy than palpation-guided IA injection in the DRUJ, and corticosteroid IA injections were effective in improving of the pain of patients with DRUJ disorder during 6 months of follow-up.
本研究的目的是针对超声（US）引导与触诊引导下关节内（IA）注射治疗桡尺远侧关节（DRUJ）疾病的中期益处和准确率开展一项随机、前瞻性单盲临床研究。患有DRUJ疾病的受试者（n = 60）被随机分配接受US引导或触诊引导的IA注射。主要结局采用手臂、肩部和手部功能障碍问卷（DASH）进行测量，次要结局包括言语数字疼痛量表（VNS）、改良梅奥腕关节评分（MMWS）、活动范围（ROM）以及两组之间的准确率；将1.25 mL混合材料（0.5 ml欧乃派克+0.25 ml 1%利多卡因+0.5 ml 20 mg曲安奈德）注入DRUJ的关节内间隙。在注射前以及注射后1、3和6个月，通过VNS、DASH、MMWS以及DRUJ的被动ROM（从中立位旋后、旋前）评估治疗效果。在对DRUJ进行US引导和触诊引导的IA注射后，拍摄X线影像以确定注射材料是否已到达关节内间隙或渗入软组织。在DRUJ中，US引导的IA注射显示出比触诊引导的IA注射显著更高的准确率（100%）。两组在1、3和6个月时VNS、DASH、MMWS和ROM均有所改善。接受US引导注射的组与接受触诊引导注射的组在临床结局方面无显著差异。在DRUJ中，US引导的IA注射显示出比触诊引导的IA注射显著更高的准确率，并且在6个月的随访期间，皮质类固醇IA注射对改善DRUJ疾病患者的疼痛有效。
