1 Department of Musculoskeletal Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239.
2 Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT.
AJR Am J Roentgenol. 2019 Apr;212(4):874-882. doi: 10.2214/AJR.18.20347. Epub 2019 Jan 23.
Because the second and third tarsometatarsal (TMT) and naviculocuneiform joints normally communicate, the least arthritic or technically most straightforward joint was injected when a fluoroscopically guided therapeutic injection was ordered for one or both joints. We hypothesized that pain relief would be equivalent regardless of the joint injected and would result in less radiation and a lower steroid dose compared with patients who had both articulations injected.
Seventy-eight patients were divided into four joint groups: naviculocuneiform requested and injected (n = 15), nonrequested naviculocuneiform or second and third TMT injected (n = 25), both injected (n = 23), and TMT requested and injected (n = 15). Variables recorded included patient age and sex, fluoroscopy time, steroid dose, pre- and postprocedural pain, osteoarthrosis (OA) grade, and confidence of intraarticular injection. Statistical analysis compared mean pain level change before and after injection, mean fluoroscopy time, and mean steroid dose between groups. The mean OA grade of the nonrequested joint was compared with that of the requested joint in patients whose injected and requested joints did not match (group 2).
Pre- and postinjection pain reduction (p = 0.630) and postinjection pain (p = 0.935) were not significantly different. Mean steroid dose (p < 0.001) and fluoroscopy time (p = 0.0001) were significantly increased for the both joint injection group. Within the nonrequested naviculocuneiform or second and third TMT injection group, there was a significant difference in OA grade between injected (least arthritic) and requested joints (p = 0.001).
When faced with challenging naviculocuneiform or second and third TMT joint injections, choosing the technically most straightforward joint may result in less radiation and steroid dose without compromising quality of care or pain reduction.
由于第二和第三跖跗（TMT）和跗舟楔关节通常相通，因此当对一个或两个关节进行荧光引导下的治疗性注射时，注射到最不关节炎或技术上最直接的关节。我们假设，无论注射哪个关节，疼痛缓解都将是等效的，并且与同时注射两个关节的患者相比，将减少辐射和类固醇剂量。
将 78 名患者分为四个关节组：请求并注射跗舟楔关节（n = 15），未请求跗舟楔关节或第二和第三 TMT 注射（n = 25），两者均注射（n = 23）和 TMT 请求并注射（n = 15）。记录的变量包括患者年龄和性别、透视时间、类固醇剂量、术前和术后疼痛、骨关节炎（OA）分级以及关节内注射的信心。统计学分析比较了各组之间注射前后平均疼痛水平变化、平均透视时间和平均类固醇剂量。比较了注射和请求关节不匹配的患者（组 2）中未请求关节和请求关节的平均 OA 分级。
注射前后疼痛减轻（p = 0.630）和注射后疼痛（p = 0.935）无显著差异。两组注射关节的平均类固醇剂量（p < 0.001）和透视时间（p = 0.0001）均显著增加。在未请求的跗舟楔关节或第二和第三 TMT 注射组中，注射（最不关节炎）和请求关节之间的 OA 分级存在显著差异（p = 0.001）。
当面临具有挑战性的跗舟楔关节或第二和第三 TMT 关节注射时，选择技术上最直接的关节可能会减少辐射和类固醇剂量，而不会影响护理质量或疼痛缓解。
