1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
2 Harvard Medical School, Department of Orthopaedic Surgery, Massachusetts General Hospital/Newton-Wellesley Hospital, Boston, MA, USA.
Foot Ankle Int. 2019 Jun;40(6):622-628. doi: 10.1177/1071100719835759. Epub 2019 Mar 13.
Little data exists regarding the incidence of adverse events and their associated risk factors following intra-articular corticosteroid injection of the ankle and subtalar joint. The aim of this study was to determine the complication rate associated with such injections and to identify any predictive risk factors.
Adult patients who had received an intra-articular ankle or subtalar joint injection between January 2000 and April 2016 at one of 3 regional hospitals (2 level 1 trauma centers and 1 community hospital) were included. Patients with prior intra-articular injection of corticosteroid into the ankle or subtalar joint were excluded. Explanatory variables were sex, age, race, body mass index, diabetes status, tobacco use, presence of fluoroscopic guidance, location of intra-articular injection, and administering physician's years of experience.
Of the 1708 patients included in the final cohort, 99 patients (5.8%) had a total of 104 adverse events within 90 days postinjection. The most prevalent types of adverse events were postinjection flare in 78 patients (4.6% of total cohort, 75% of adverse events) followed by skin reaction in 10 patients (0.6% of total cohort, 9% of adverse events). No infections were noted. Multivariable logistic regression analysis found that intra-articular injection in the subtalar ( P = .004) was independently associated with development of an adverse event. Fluoroscopic guidance was not found to be protective of an adverse event compared to nonguided injections ( P = .476).
The adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection was 5.8%, with postinjection flare being the most common complication. Infections following injection were not reported. Injection into the subtalar joint was independently associated with the development of an adverse event after intra-articular corticosteroid injection, and this was not mitigated by the use of fluoroscopic guidance.
Level III, retrospective comparative study.
关于踝关节和跗骨关节关节内皮质类固醇注射后不良事件及其相关危险因素的数据很少。本研究的目的是确定与这些注射相关的并发症发生率，并确定任何预测性危险因素。
纳入 2000 年 1 月至 2016 年 4 月期间在 3 家地区医院（2 家 1 级创伤中心和 1 家社区医院）接受踝关节或跗骨关节关节内注射的成年患者。排除先前在踝关节或跗骨关节关节内注射皮质类固醇的患者。解释变量为性别、年龄、种族、体重指数、糖尿病状况、吸烟状况、是否有荧光镜引导、关节内注射部位和实施医生的工作年限。
在最终队列的 1708 例患者中，99 例（5.8%）在注射后 90 天内共发生 104 例不良事件。最常见的不良事件类型是注射后 flare 78 例（总队列的 4.6%，不良事件的 75%），其次是皮肤反应 10 例（总队列的 0.6%，不良事件的 9%）。没有感染的病例。多变量逻辑回归分析发现，跗骨关节内注射（P =.004）与不良事件的发生独立相关。与非引导注射相比，荧光镜引导并未发现对不良事件有保护作用（P =.476）。
踝关节或跗骨关节关节内皮质类固醇注射后不良事件的发生率为 5.8%，注射后 flare 是最常见的并发症。未报告注射后感染。关节内注射后，跗骨关节内注射与关节内皮质类固醇注射后不良事件的发生独立相关，而荧光镜引导并不能减轻这种相关性。
III 级，回顾性比较研究。
