Baria Michael R, Sellon Jacob L, Lueders Dan, Smith Jay
The Ohio State University Sports Medicine Center & Department of Physical Medicine and Rehabilitation, Columbus, OH(∗).
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN(†).
PM R. 2017 Oct;9(10):998-1005. doi: 10.1016/j.pmrj.2016.12.012. Epub 2017 Jan 16.
There is a growing interest in the use of biologic agents such as platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal injuries, including meniscal tears. Although previous research has documented the role of diagnostic ultrasound to evaluate meniscal tears, sonographically guided (SG) techniques to specifically deliver therapeutic agents into the meniscus have not been described.
To describe and validate SG injection techniques for the body and posterior horn of the medial and lateral meniscus.
Prospective, cadaveric laboratory investigation.
Academic institution procedural skills laboratory.
Five unenbalmed cadaveric knee-ankle-foot specimens from 5 donors (3 female and 2 male) ages 33-92 years (mean age 74 years) with body mass indices of 21.1-32.4 kg/m (mean 24.1 kg/m).
A single, experienced operator completed SG injections into the bodies and posterior horns of the medial and lateral menisci of 5 unenbalmed cadaveric knees using colored latex and a 22-gauge, 38-mm needle. After injection, coinvestigators dissected each specimen to assess latex distribution within the menisci and identify injury to intra-articular and periarticular structures.
Latex location within the target region of meniscus (accurate/inaccurate), and iatrogenic injury to "at risk" intra- and periarticular structures (present/absent).
Seventeen of 20 injections were accurate. Two of 3 inaccurate injections infiltrated the posterior horn of the medial meniscus instead of the targeted meniscal body. One inaccurate lateral meniscus injection did not contain latex despite sonographically accurate needle placement. No specimen exhibited injury to regional neurovascular structures or intra-articular hyaline cartilage.
SG meniscus injections are feasible and can accurately and safely deliver injectates such as regenerative agents into bodies and posterior horns of the medial and lateral menisci. The role of SG intrameniscal injections in the treatment of patients with degenerative and traumatic meniscal disorders warrants further exploration.
Not applicable.
人们越来越关注使用生物制剂，如富含血小板的血浆和间充质干/基质细胞，来治疗包括半月板撕裂在内的肌肉骨骼损伤。尽管先前的研究已经记录了诊断超声在评估半月板撕裂中的作用，但尚未描述超声引导（SG）技术将治疗剂特异性地输送到半月板中的方法。
描述并验证用于内侧和外侧半月板体部及后角的SG注射技术。
前瞻性尸体实验室研究。
学术机构程序技能实验室。
来自5名供体（3名女性和2名男性）的5个未防腐处理的尸体膝-踝-足标本，年龄33 - 92岁（平均年龄74岁），体重指数为21.1 - 32.4 kg/m²（平均24.1 kg/m²）。
由一名经验丰富的操作人员使用彩色乳胶和22号、38毫米的针头，对5个未防腐处理的尸体膝关节的内侧和外侧半月板体部及后角进行SG注射。注射后，共同研究者解剖每个标本，以评估乳胶在半月板内的分布情况，并确定关节内和关节周围结构是否受损。
乳胶在半月板目标区域内的位置（准确/不准确），以及对“有风险”的关节内和关节周围结构的医源性损伤（存在/不存在）。
20次注射中有17次准确。3次不准确的注射中有2次注入了内侧半月板后角而非目标半月板体部。1次外侧半月板注射不准确，尽管超声引导下针头放置准确，但未含乳胶。没有标本显示区域神经血管结构或关节内透明软骨受损。
SG半月板注射是可行的，并且能够准确、安全地将诸如再生剂等注射剂输送到内侧和外侧半月板的体部及后角。SG半月板内注射在治疗退行性和创伤性半月板疾病患者中的作用值得进一步探索。
不适用。
