Axe Jeremie M, Axe Michael J
Tufts Medical Center, Boston, Mass, USA.
First State Orthopaedics, Newark, Del, USA.
Del Med J. 2013 Oct;85(10):303-6; quiz 315.
Unguided approaches have not demonstrated evidence of highly accurate intra-articular glenohumeral injections. The purpose of this study was to assess the accuracy of a posterior approach bone touch technique in conscious subjects without shoulder pathology as a first step in developing an accurate, reliable technique for use in patients.
Twenty-six young subjects (age 22-26) without shoulder pathology (BMI 24 +/- 3), had bilateral shoulders injected while awake and seated. A 20 gauge 3.5-inch needle was introduced 1.5 cm below the scapular spine mid-way between the posterior lateral acromial corner and the posterior axillary crease. In Trial I, 20 shoulders were injected. After touching the humerus, the arm was oscillated. The needle advanced to 4-5 cm and 10 mL of dye injected. Pop and ease of flow were recorded. Immediate room change, spot fluoroscopy, and independent experienced radiology reading followed. In Trial II, 32 shoulders were injected. The technique was modified to touching the humerus, externally rotating the arm 25 degrees, and while remaining in bone contact, delivering 10 mL of dye. The same data as Trial I was recorded.
In Trial I, 14/20 (70 percent) had dye within the glenohumeral joint. Five of seven failures were too anterior showing dye around the subscapularis muscle and all were associated with a pop. In Trial II, 31/32 (97 percent) had dye within glenohumeral joint. Twenty-three of 32 (72 percent) had a "pop," including the failure. Overall, 45/52 (87 percent) had dye within glenohumeral joint. Thirty-one of 52 (71 percent) of all shoulders had a "pop." Twenty-three of 52 (44 percent) shoulders had pain, resolving within 24 hours.
A modified (Delaware) posterior bone touch technique for glenohumeral joint injection is 97 percent accurate in conscious healthy young subjects. Pop and ease of flow are not always indicative of correct needle placement. This study serves as an important first step in determining an optimum approach for injecting pathologic glenohumeral joints with corticosteroids or hyaluronic acid.
IV Case Series.
非引导式方法尚未证明有高度准确的盂肱关节腔内注射的证据。本研究的目的是评估在无肩部病变的清醒受试者中后入路骨触诊技术的准确性，作为开发一种准确、可靠的用于患者的技术的第一步。
26名无肩部病变（体重指数24±3）的年轻受试者（年龄22 - 26岁），在清醒且坐位时双侧肩部接受注射。使用一根20号3.5英寸的针头，在肩胛冈下方1.5厘米处，位于肩峰后外侧角与腋窝后皱襞之间的中点处进针。在试验I中，对20个肩部进行注射。触及肱骨后，摆动手臂。将针头推进至4 - 5厘米并注入10毫升染料。记录有无“噗”的声音及染料流动的顺畅程度。随后进行即时房间内改变、点片透视以及由独立的经验丰富的放射科医生阅片。在试验II中，对32个肩部进行注射。技术改进为触及肱骨后，将手臂外旋25度，在保持与骨接触的同时注入10毫升染料。记录与试验I相同的数据。
在试验I中，20个肩部中有14个（70%）染料注入了盂肱关节内。7例失败中有5例过于靠前，染料显示在肩胛下肌周围，且所有这些都伴有“噗”的声音。在试验II中，32个肩部中有31个（97%）染料注入了盂肱关节内。32个肩部中有23个（72%）出现了“噗”的声音，包括那例失败的情况。总体而言，52个肩部中有45个（87%）染料注入了盂肱关节内。所有肩部中有31个（71%）出现了“噗”的声音。52个肩部中有23个（44%）出现疼痛，在24小时内缓解。
改良的（特拉华）盂肱关节注射后入路骨触诊技术在清醒的健康年轻受试者中准确率为97%。“噗”的声音及染料流动的顺畅程度并不总是表明针头放置正确。本研究是确定用皮质类固醇或透明质酸注射病理性盂肱关节的最佳方法的重要第一步。
IV级病例系列。
