Nottrott K, De Guio C, Khairoun A, Schramme M
Pole Equin, VetAgro Sup, Marcy L'Étoile, France.
Equine Vet J. 2017 Sep;49(5):655-661. doi: 10.1111/evj.12673. Epub 2017 Feb 28.
Navicular disease in the horse often requires injection of the navicular bursa. We have developed an ultrasound-guided, lateral needle approach to navicular bursocentesis, which avoids penetration of the deep digital flexor tendon (DDFT) and the need for radiographic control.
To describe and evaluate the feasibility and efficacy of an ultrasound-guided, lateral bursocentesis technique.
Cadaveric and in vivo experiments.
The navicular bursa in 62 cadaveric forelimbs of 31 horses and in both forelimbs of 26 live horses, positioned with the foot flexed in a navicular block, were submitted to lateral, ultrasound-guided injection of 1.5 ml radiocontrast agent. Lateromedial radiographs were taken to locate the contrast. A second injection of 0.5 ml methylene blue was administered during needle withdrawal in cadaveric limbs to investigate the needle pathway during dissection.
Contrast agent was successfully deposited in the navicular bursa in 104 of 114 (91%) limbs and in the navicular bursa alone in 89 of 114 (78%) limbs. Dissection showed no evidence of penetration of the DDFT in cadaver limbs. Failure to inject the navicular bursa was significantly associated with poor quality of the ultrasound image (P = 0.04) and resulted in aberrant injection of the distal interphalangeal joint in five of 114 (4%) limbs, the peribursal soft tissues in four of 114 (4%) limbs and the digital flexor tendon sheath in one of 114 (0.9%) limbs. Synovial fluid was observed at the needle hub in 58% of live horses.
It is unknown whether injection results obtained in the limbs of horses without disease can be extrapolated to horses with clinical disease of the podotrochlear apparatus. The localisation of contrast medium on radiographs may not accurately reflect the behaviour of local anaesthetic solution or therapeutic medications injected in the navicular bursa.
This lateral, ultrasound-guided technique for injecting the navicular bursa is effective, does not penetrate the DDFT and avoids exposure of personnel to radiation.
马的舟状骨疾病通常需要对舟状囊进行注射。我们开发了一种超声引导下的外侧进针舟状囊穿刺方法，该方法可避免穿透指深屈肌腱（DDFT）且无需影像学控制。
描述并评估超声引导下外侧囊穿刺技术的可行性和有效性。
尸体和活体实验。
对31匹马的62个尸体前肢以及26匹活马的双前肢进行舟状囊穿刺，将足部屈曲置于舟状骨阻滞位，在超声引导下从外侧注入1.5 ml放射性造影剂。拍摄内外侧X线片以定位造影剂。在尸体肢体拔针过程中再注入0.5 ml亚甲蓝，以在解剖时研究针的路径。
114个肢体中的104个（91%）造影剂成功注入舟状囊，其中仅89个（78%）肢体的造影剂仅注入舟状囊。解剖显示尸体肢体中没有指深屈肌腱穿透的迹象。未能注入舟状囊与超声图像质量差显著相关（P = 0.04），并导致114个肢体中的5个（4%）远端指间关节异常注射，114个肢体中的4个（4%）囊周软组织异常注射，以及114个肢体中的1个（0.9%）指屈肌腱鞘异常注射。58%的活马在针座处观察到滑液。
尚不清楚在无疾病马匹肢体上获得的注射结果是否可外推至患有跗中关节装置临床疾病的马匹。X线片上造影剂的定位可能无法准确反映注入舟状囊的局部麻醉溶液或治疗药物的行为。
这种超声引导下外侧注射舟状囊的技术是有效的，不会穿透指深屈肌腱，且可避免人员暴露于辐射。
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