Orthopedic Department, Poriya Government Hospital, Tiberias, Israel.
Orthopedic Department, Poriya Government Hospital, Tiberias, Israel.
J Shoulder Elbow Surg. 2014 Oct;23(10):e243-50. doi: 10.1016/j.jse.2014.01.012. Epub 2014 Apr 13.
Injection into the acromioclavicular (AC) joint is often inaccurate (approximately 50%) even in experienced hands. In light of new anatomic observations, we evaluate accuracy of an innovative ultrasound-guided method and follow the clinical course of successful therapeutic injections.
Relevant anatomy was investigated in 200 three-dimensional computed tomography scans, 100 magnetic resonance images, and 14 cadavers. Baseline measurements of joint depth and width were performed ultrasonically in 100 normal volunteers; 50 symptomatic patients were injected. Uniquely in a clinical ultrasound study, injection success was documented by arthrography. Outcomes after concomitant steroid instillation were observed for 6 months by visual analog scale (VAS) scores and pain provocation test results.
Anatomic studies showed that the widest area for joint penetration was anterior superior. Injection success rate was 96%, overwhelmingly on the first needle pass. Shallow joint depth allowed access with a standard 3-cm needle. Joint width diminished with age but did not reduce injection success. Cadaveric joints admitted 1.2 ± 0.5 mL, but fluid ingress was initially blocked by soft tissues in one third of both cadaveric and clinical cases. Diligent follow-up after steroid injection showed sustained pain relief in the majority with isolated AC disease but significantly less in those with concomitant shoulder disorders.
This high level of clinical injection success, irrefutably substantiated with arthrography, has not been previously demonstrated. The anterior superior aspect of the joint is the preferred place for entry. Initial intra-articular blockage to fluid inflow is common but can be surmounted. Encouraging 6-month results of steroid instillation in isolated AC disease do not apply to patients with coexisting shoulder pathologic processes.
即使在经验丰富的手中，肩锁关节（AC）关节内注射也常常不准确（约 50%）。鉴于新的解剖学观察结果，我们评估了一种创新的超声引导方法的准确性，并跟踪了成功治疗性注射的临床过程。
在 200 例三维 CT 扫描、100 例磁共振成像和 14 例尸体中研究了相关解剖结构。在 100 名正常志愿者中进行了关节深度和宽度的超声基线测量；对 50 名有症状的患者进行了注射。在一项临床超声研究中，关节造影术记录了注射的成功。通过视觉模拟评分（VAS）评分和疼痛诱发试验结果，观察 6 个月内同时进行类固醇灌洗的结果。
解剖学研究表明，关节穿透的最宽区域是前上。注射成功率为 96%，绝大多数在第一次进针时就成功了。关节深度较浅，允许使用标准的 3 厘米长的针进行穿刺。关节宽度随年龄而减小，但不会降低注射成功率。尸体关节可容纳 1.2±0.5 毫升，但在尸体和临床病例中，三分之一的关节内初始有软组织阻挡液体进入。类固醇注射后进行的仔细随访显示，对于孤立性 AC 疾病的大多数患者，疼痛缓解持续，但对于同时伴有肩部疾病的患者，缓解程度显著降低。
这种高水平的临床注射成功率，通过关节造影术无可置疑地证实了这一点，以前从未有过报道。关节的前上部位是进入的首选部位。初始关节内液体流入阻塞很常见，但可以克服。在孤立性 AC 疾病中，类固醇灌洗 6 个月的结果令人鼓舞，但不适用于同时存在肩部病理过程的患者。
