To Philip, McClary Kaylan N, Sinclair Micah K, Stout Brittany A, Foad Mohab, Hiratzka Shannon, Stern Peter J
1 OrthoArizona, Scottsdale, USA.
2 University of Cincinnati, OH, USA.
Hand (N Y). 2017 Nov;12(6):591-596. doi: 10.1177/1558944717692086. Epub 2017 Feb 1.
The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint.
Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis.
The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful.
Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.
本研究的目的是确定在有或没有超声（U/S）辅助的情况下，向腕管、拇指腕掌（CMC）关节、第一背侧间室（DC）和桡腕（RC）关节进行手部注射的准确性。
四名具有不同经验水平的参与者将蓝色染料和放射造影剂注入40个新鲜冷冻尸体标本的腕管、拇指CMC关节、第一DC和RC关节。参与者1和2在没有U/S引导的情况下进行注射，参与者3和4在U/S引导下进行注射。通过荧光透视和解剖/直接观察来确定注射是否成功。记录每次注射的其他信息，如正中神经浸润情况和拇指CMC关节病的证据。
腕管、拇指CMC关节、第一DC和RC关节注射的总体准确率分别为95%、63%、90%和90%。比较了有和没有U/S引导时的成功率。除拇指CMC关节外，每个注射部位的成功率相似，在拇指CMC关节，使用U/S的参与者准确率高25%。在拇指CMC关节病的情况下，没有U/S辅助的参与者成功率为38%，有U/S辅助的参与者成功率为72%。使用U/S的参与者之间存在显著差异，U/S经验更丰富的参与者更成功。
腕管、第一DC和RC关节注射的准确率大于90%。拇指CMC关节注射的准确率较低（63%），使用U/S可提高准确率。U/S引导注射的准确率取决于使用者及其经验。
