Naylor Jason F, Dekay Kenneth B, Donham Benjamin P, Hall Brian T
Department of Emergency Medicine, Carl R. Darnall Army Medical Center 36000 Darnall Loop, Fort Hood, TX 76544.
Mil Med. 2017 Mar;182(S1):216-221. doi: 10.7205/MILMED-D-16-00055.
Several studies have demonstrated ultrasound (US) is superior to traditional landmark (LM)-based techniques for large and medium joint aspiration; however, no studies of sufficient size have evaluated these interventions in the smaller toe joints. The purpose of this study was to determine if US provides an advantage over LM for successful first-pass aspiration of first metatarsophalangeal joint (1st MTPJ) effusions.
A cross-over, cadaveric trial evaluating the interventions of US and LM. Eighteen emergency medicine residents performed four US and four LM aspirations each of 1st MTPJ effusions simulated in fresh-frozen cadavers. The initial intervention utilized was randomized. The primary outcome measured was aspiration success or failure. A secondary outcome measured was time in seconds taken to complete a successful aspiration.
A total of 144 1st MTPJ aspirations were attempted-72 by US and 72 by LM. US was the initial intervention used in 9 of 18 (50%) participants. Fifty-seven of 72 (79.2%) US attempts were successful, while 53 of 72 (73.6%) LM attempts were successful (95% confidence interval 69.5%, 83.3%; p = 0.56). Successful US aspirations took 43.7 seconds (±31.0), whereas successful LM aspirations averaged 34.0 seconds (±24.3). The mean difference in time to successful aspiration was 9.7 seconds (95% confidence interval 20.3, -0.9; p = 0.07). There was no statistically significant difference in success and time between US and LM.
In this study, US did not prove superior to LM for first-pass aspiration of 1st MTPJ effusions.
多项研究表明，在大中型关节穿刺方面，超声（US）优于传统的基于体表标志（LM）的技术；然而，尚无足够规模的研究对较小的趾关节的这些干预措施进行评估。本研究的目的是确定在首次成功穿刺第一跖趾关节（第1 MTPJ）积液方面，超声是否比体表标志具有优势。
一项交叉尸体试验，评估超声和体表标志两种干预措施。18名急诊医学住院医师对新鲜冷冻尸体模拟的第1 MTPJ积液分别进行4次超声引导穿刺和4次体表标志引导穿刺。最初采用的干预措施是随机的。主要测量结果是穿刺成功或失败。次要测量结果是成功完成穿刺所需的时间（以秒为单位）。
共尝试了144次第1 MTPJ穿刺，其中超声引导穿刺72次，体表标志引导穿刺72次。18名参与者中有9名（50%）最初采用超声引导穿刺。超声引导穿刺的72次尝试中有57次（79.2%）成功，而体表标志引导穿刺的72次尝试中有53次（73.6%）成功（95%置信区间69.5%，83.3%；p = 0.56）。超声引导穿刺成功用时43.7秒（±31.0），而体表标志引导穿刺成功平均用时34.0秒（±24.3）。成功穿刺的时间平均差异为9.7秒（95%置信区间20.3，-0.9；p = 0.07）。超声引导穿刺和体表标志引导穿刺在成功率和时间上无统计学显著差异。
在本研究中，对于首次穿刺第1 MTPJ积液，超声并未显示出优于体表标志的效果。
