Ford T S, Ross M W, Orsini P G
Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square 19348.
Vet Surg. 1989 Mar-Apr;18(2):146-50. doi: 10.1111/j.1532-950x.1989.tb01059.x.
Three techniques for inducing analgesia of the proximal metacarpal region were evaluated for the frequency of inadvertent injection into the middle carpal and carpometacarpal joints. Using methylene blue solution as a marker dye and 30 fresh cadaver specimens each, three clinicians performed either 30 infiltrations at the origin of the suspensory ligament (method A), 30 palmar and palmar metacarpal nerve blocks at the proximal end of the metacarpus (method B), or 30 palmar and palmar metacarpal nerve blocks at the distal aspect of the accessory carpal bone (method C). The frequency of inadvertent injection into the distal carpal joints was 37, 17, and 0% for methods A, B, and C, respectively. The association between method and injection into the joints was significant (p less than 0.01). Infiltration of the distal carpal joints occurred with injection distances from the carpometacarpal joint of 1.5 to 4.5 cm. Although there was no joint injection with method C, the carpal synovial sheath was inadvertently infiltrated in 68% of the specimens. Injection into the distal carpal joints can occur when deep injections are made into the proximal palmar aspect of the metacarpus because of the distopalmar outpouchings of the carpometacarpal joint between the axial surfaces of the second and fourth metacarpal bones and the abaxial surface of the suspensory ligament.
评估了三种诱导掌骨近端区域镇痛的技术，以确定意外注入腕中关节和腕掌关节的频率。三位临床医生分别使用亚甲蓝溶液作为标记染料，并以30个新鲜尸体标本为对象，在悬韧带起点处进行30次浸润（方法A），在掌骨近端进行30次掌侧和掌骨掌侧神经阻滞（方法B），或在副腕骨远端进行30次掌侧和掌骨掌侧神经阻滞（方法C）。方法A、B和C意外注入腕远端关节的频率分别为37%、17%和0%。方法与关节内注射之间的关联具有显著性（p小于0.01）。腕远端关节的浸润发生在距腕掌关节1.5至4.5厘米的注射距离处。虽然方法C未出现关节内注射，但68%的标本意外浸润了腕滑膜鞘。由于第二和第四掌骨轴面与悬韧带背面之间的腕掌关节向掌侧远端突出，当向掌骨近端掌侧进行深部注射时，可能会发生注入腕远端关节的情况。
