Kraeutler Matthew J, Garabekyan Tigran, Fioravanti Matthew J, Young David A, Mei-Dan Omer
Department of Orthopaedic Surgery, Seton Hall-Hackensack Meridian School of Medicine, South Orange, NJ, USA.
Southern California Hip Institute, North Hollywood, CA, USA.
J Hip Preserv Surg. 2018 May 3;5(3):220-225. doi: 10.1093/jhps/hny013. eCollection 2018 Aug.
The purpose of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic. A retrospective study of prospectively collected data was performed in a consecutive cohort of patients diagnosed with symptomatic intra-articular hip pathology who underwent a non-image-guided intra-articular injection in the clinic. All patients had clinical and radiographic evidence of hip impingement, hip instability, chondrolabral pathology, or other causes of intra-articular hip pain. A previously described technique for a non-image-guided hip injection was performed using 7-10 ml of 1% lidocaine for diagnostic evaluation with some patients receiving 2 ml of Kenalog-40 if clinically indicated. Ten minutes following each injection, the patient was asked to report the percent improvement in pain (from 0 to 100%) while physical examination and provocative tests were repeated. The final study cohort comprised 142 patients (161 injections). In three cases, patients were either unable to assess or quantify any change in pain level 10 min following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). Average pain relief among all 158 injections was 89 ± 16%. A non-image-guided diagnostic intra-articular hip injection yields reliable short-term pain relief, simultaneously endorsing accurate diagnosis of hip pathology and intra-articular needle placement.
本研究的目的是通过在临床床边进行的非影像引导下髋关节腔内注射，确定疼痛缓解的可能性，以此作为髋关节腔内病变准确诊断和正确进针位置的一项衡量指标。对前瞻性收集的数据进行回顾性研究，研究对象为连续队列中被诊断为有症状的髋关节腔内病变且在临床接受非影像引导下髋关节腔内注射的患者。所有患者均有髋关节撞击、髋关节不稳定、髋臼盂唇病变或其他髋关节腔内疼痛原因的临床和影像学证据。采用先前描述的非影像引导下髋关节注射技术，使用7 - 10毫升1%利多卡因进行诊断评估，部分患者根据临床指征接受2毫升曲安奈德-40。每次注射后10分钟，要求患者报告疼痛改善的百分比（从0到100%），同时重复体格检查和激发试验。最终研究队列包括142例患者（161次注射）。在3例患者中，患者在注射后10分钟无法评估或量化疼痛水平的任何变化。在其余158次髋关节注射中，156例（156/158，98.7%）出现疼痛缓解，152例（152/158，96.2%）疼痛水平改善至少70%。所有158次注射的平均疼痛缓解率为89±16%。非影像引导下的诊断性髋关节腔内注射能产生可靠的短期疼痛缓解，同时支持对髋关节病变的准确诊断和关节腔内进针位置的正确性。
