Lee Sung Yup, Gn Kiran Kumar, Chung Byung June, Lee Sang Wook, Kim Tae Kyun
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Joint Reconstruction Center, Knee and Spine Hospital, Seoul, Korea.
Knee Surg Relat Res. 2015 Dec;27(4):228-32. doi: 10.5792/ksrr.2015.27.4.228. Epub 2015 Dec 1.
Intra-articular knee injections are commonly performed in clinical practice for treating various knee joint disorders such as osteoarthritis and rheumatoid arthritis. When selecting the portal for injection, not only intra-articular needle accuracy but also procedural pain should be taken into consideration. The purpose of this study was to determine whether injection through anterolateral portal provokes less pain and provides better pain relief compared to superolateral portal.
A total of 60 patients with primary osteoarthritis of the knee receiving intra-articular injections were randomized into 2 groups according to the type of portal approach; anterolateral or superolateral. All patients received hyaluronic acid (20 mg) and triamcinolone (40 mg) as the first injection followed by second and third injections of hyaluronic acid on a weekly basis. Underlying knee pain, procedural pain, and knee pain at 4 weeks were evaluated using visual analogue scale (VAS).
Injection through anterolateral portal provoked less pain (VAS, 1.5±1.3) than the superolateral portal (VAS, 1.5 vs. 2.7; p=0.004). No differences were found in the degree of pain relief at weeks between the two groups (p=0.517).
We recommend the use of anterolateral portal for intra-articular knee injection as it provokes less pain and comparably short-term pain relief than the superolateral portal.
膝关节腔内注射在临床实践中常用于治疗各种膝关节疾病，如骨关节炎和类风湿性关节炎。在选择注射入口时，不仅要考虑关节内注射针的准确性，还要考虑操作过程中的疼痛。本研究的目的是确定与上外侧入口相比，通过前外侧入口注射是否引起更少的疼痛并提供更好的疼痛缓解。
总共60例接受膝关节腔内注射的原发性膝骨关节炎患者根据注射入口类型随机分为2组；前外侧或上外侧。所有患者首次注射时接受透明质酸（20mg）和曲安奈德（40mg），随后每周进行第二次和第三次透明质酸注射。使用视觉模拟量表（VAS）评估基础膝关节疼痛、操作过程中的疼痛以及4周时的膝关节疼痛。
通过前外侧入口注射引起的疼痛（VAS，1.5±1.3）比上外侧入口少（VAS，1.5对2.7；p = 0.004）。两组之间在各周的疼痛缓解程度上没有差异（p = 0.517）。
我们建议在膝关节腔内注射时使用前外侧入口，因为它比上外侧入口引起的疼痛更少，且短期疼痛缓解效果相当。
