School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
Department of Obstetrics and Gynaecology, Royal Hospital for Women, Randwick, NSW, Australia.
Ultrasound Obstet Gynecol. 2018 Mar;51(3):396-400. doi: 10.1002/uog.17537.
Botulinum toxin-A (BoNT-A) is used in the treatment of pelvic floor muscle overactivity associated with chronic pelvic pain (CPP) when conservative methods such as physiotherapy are not effective or appropriate. Traditional injection techniques require finger-guided palpation of pelvic floor muscles with concurrent insertion of the needle. The aim of this study was to describe a novel technique for the injection of BoNT-A into the pelvic floor musculature using four-dimensional ultrasound (4D-US) guidance.
Thirty-one BoNT-A injections were performed using the new technique between October 2013 and January 2016, on women scheduled to have BoNT-A injection for pelvic floor muscle overactivity and CPP. The pelvic floor was assessed by 4D-US. A test injection of saline was performed to confirm location of the needle, then BoNT-A was injected into the muscle under ultrasound guidance, using 4D-US to confirm that the fluid expanded and tracked along muscle fibers.
The saline test confirmed correct location of the needle following a median of 1 (range, 1-3) attempt at needle placement. In all 31 instances, satisfactory injection of BoNT-A, with 4D-US confirmation of fluid expansion within the muscle body, was performed.
Injection of BoNT-A under 4D-US guidance is feasible and allows accurate placement into the target muscle in women with pelvic floor muscle overactivity associated with CPP. This technique may provide a safer alternative to finger-guided methods, owing to a lower likelihood of operator needle-stick injury. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
当物理疗法等保守方法无效或不适用时，肉毒杆菌毒素 A（BoNT-A）用于治疗与慢性盆腔痛（CPP）相关的盆底肌肉过度活动。传统的注射技术需要手指引导触诊盆底肌肉，并同时插入针头。本研究旨在描述一种使用四维超声（4D-US）引导将 BoNT-A 注射到盆底肌肉中的新技术。
2013 年 10 月至 2016 年 1 月，对计划接受 BoNT-A 注射以治疗盆底肌肉过度活动和 CPP 的女性，使用新技术进行了 31 次 BoNT-A 注射。通过 4D-US 评估盆底。进行盐水测试注射以确认针头的位置，然后在超声引导下将 BoNT-A 注入肌肉，使用 4D-US 确认液体在肌肉纤维中扩张和跟踪。
在中位数为 1（范围 1-3）次尝试放置针头后，盐水测试确认了正确的针头位置。在所有 31 例中，均成功进行了 BoNT-A 的满意注射，并通过 4D-US 确认了肌肉内的液体扩张。
在 4D-US 引导下注射 BoNT-A 是可行的，可以在与 CPP 相关的盆底肌肉过度活动的女性中准确地将药物注射到目标肌肉中。与手指引导方法相比，这种技术可能提供更安全的替代方法，因为操作者针头刺伤的可能性较低。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
