Huang Zhongming, Du Shaohua, Qi Yiying, Chen Guangnan, Yan Weiqi
From the Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Am J Phys Med Rehabil. 2015 Oct;94(10):775-83. doi: 10.1097/PHM.0000000000000260.
The aim of this study was to evaluate the effectiveness and accuracy of ultrasound-guided intraarticular and periarticular joint injections as compared with landmark-guided injections technique.
A systematic literature search was performed in Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and other sources. Only randomized controlled trials were included. Two reviewers independently selected and assessed each study for quality and extracted data.
Twelve randomized controlled trials were included in the meta-analysis. The results indicated that ultrasound-guided intraarticular and periarticular joint injections were more accurate than the landmark-guided injections (odds ratio, 0.36; 95% confidence interval, 0.22-0.60). Ultrasound-guided joint injections significantly decreased the visual analog scale scores at both 2 wks (mean difference, -9.57; 95% confidence interval, -13.14 to -5.99) (P < 0.00001) and 6 wks (mean difference, -14.21; 95% confidence interval, -18.20 to -10.21) (P < 0.00001) after injection. There was no statistically significant difference in visual analog scale score at 12 wks between ultrasound-guided and landmark-guided intraarticular and periarticular joint injections (mean difference, -4.42; 95% confidence interval, -11.71 to 2.87) (P = 0.23).
Intraarticular and periarticular injections using ultrasound guidance significantly improves the accuracy of joint injections, and there is a significant decrease in visual analog scale scores for up to 6 wks after injection. The effect of ultrasound guidance on the long-term outcome of joint injections is inconclusive. The improved accuracy of injections was associated with pain relief. The authors recommend routine ultrasound guidance for intraarticular and periarticular injections.
本研究旨在评估超声引导下关节内及关节周围注射与体表标志引导注射技术相比的有效性和准确性。
在Medline、科学网、Embase、Cochrane对照试验中心注册库、文章参考文献列表及其他来源进行系统的文献检索。仅纳入随机对照试验。两名评价者独立选择并评估每项研究的质量并提取数据。
荟萃分析纳入了12项随机对照试验。结果表明，超声引导下关节内及关节周围注射比体表标志引导注射更准确（优势比，0.36；95%置信区间，0.22 - 0.60）。超声引导下关节注射在注射后2周（平均差值，-9.57；95%置信区间，-13.14至-5.99）（P < 0.00001）和6周（平均差值，-14.21；95%置信区间，-18.20至-10.21）（P < 0.00001）时显著降低了视觉模拟评分。超声引导与体表标志引导的关节内及关节周围注射在12周时视觉模拟评分无统计学显著差异（平均差值，-4.42；95%置信区间，-11.71至2.87）（P = 0.23）。
超声引导下关节内及关节周围注射显著提高了关节注射的准确性，且注射后长达6周视觉模拟评分显著降低。超声引导对关节注射长期结果的影响尚无定论。注射准确性的提高与疼痛缓解相关。作者建议对关节内及关节周围注射采用常规超声引导。
