Zhang MaryAnn, Pessina Monica A, Higgs Jay B, Kissin Eugene Y
Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA.
J Med Ultrasound. 2018 Apr-Jun;26(2):77-80. doi: 10.4103/JMU.JMU_8_17. Epub 2018 Jun 12.
We evaluated the risk of lateral circumflex femoral artery (LCFA) injury during ultrasound-guided intra-articular hip injections.
This study was divided into three parts. (1) Four ultrasound-guided hip injections were performed on human cadavers. With needles in place, tissues were dissected to expose the LCFA. (2) Ultrasound-trained rheumatologists marked a planned needle trajectory from skin to hip joint on live human ultrasound images during an Observed Structured Clinical Examination (OSCE). Doppler was subsequently activated to locate the LCFA, and the distance between trajectory and arterial signal was recorded. (3) Rheumatologists certified in musculoskeletal ultrasound were surveyed about joint injection vascular complications.
(1) In one of the four cadaveric dissections, the needle made direct contact with the LCFA. (2) Of 27 OSCE participants, only two activated Doppler before marking simulated hip injection trajectories. Trajectories passed through LCFA Doppler signal in six (22%) cases. Mean minimal distance from trajectory to arterial signal was 4 mm (range, 0-11 mm). (3) Of 62 survey respondents, 24% stated that they did not use Doppler routinely. While none reported bleeding injuries with their patients, 16% knew of a hip injection-related vascular complication performed by another provider.
There is a risk of LCFA injury during ultrasound-guided hip joint injection. Routine use of Doppler should be considered in standard hip injection protocols.
我们评估了超声引导下髋关节腔内注射时股外侧旋动脉（LCFA）损伤的风险。
本研究分为三个部分。（1）在人体尸体上进行了四次超声引导下的髋关节注射。在针就位后，解剖组织以暴露LCFA。（2）在观察性结构化临床检查（OSCE）期间，接受过超声培训的风湿病学家在实时人体超声图像上标记了从皮肤到髋关节的计划针道。随后启动多普勒以定位LCFA，并记录针道与动脉信号之间的距离。（3）对获得肌肉骨骼超声认证的风湿病学家进行了关于关节注射血管并发症的调查。
（1）在四次尸体解剖中的一次，针直接接触了LCFA。（2）在27名OSCE参与者中，只有两人在标记模拟髋关节注射针道之前启动了多普勒。针道在6例（22%）病例中穿过了LCFA多普勒信号。针道与动脉信号之间的平均最小距离为4毫米（范围为0至11毫米）。（3）在62名调查受访者中，24%表示他们并非常规使用多普勒。虽然没有人报告其患者发生出血性损伤，但16%知道另一位医生进行的与髋关节注射相关的血管并发症。
超声引导下髋关节注射存在LCFA损伤的风险。在标准髋关节注射方案中应考虑常规使用多普勒。
