The University of Chicago Medicine & Biological Sciences, IL, USA.
Hand (N Y). 2021 Jan;16(1):86-92. doi: 10.1177/1558944719846572. Epub 2019 May 1.
Arthritis involving the thumb carpometacarpal (CMC) joint is common in the adult population. Initial treatment includes corticosteroid injections. Injections can be performed with image guidance to assist with placement; however, the clinical benefits are unclear. This retrospective study used Truven Health Marketscan Research Databases to identify patients from 2003 to 2014 with common International Classification of Diseases, Ninth Revision (ICD-9) codes for osteoarthritis of the CMC joint, Common Procedural Terminology (CPT) codes for image and non-image-guided injections, and codes for surgical interventions. Length of time from injection until subsequent injection(s) and/or surgery was extrapolated for identified patients. Analysis of variance and binomial logistic regression were used to compare continuous variables and calculate odds ratios, respectively. We identified 62 333 patients (68% women, 32% men), average age 59.7, with common ICD-9 diagnostic codes for CMC arthritis with respective injection CPT codes. The average number of days between the first and second injection for patients treated with non-guided injection was 237.3 versus 266.7 for image-guided injections. Of the 62333 patients, 8107 went on to operative treatment. Among operative patients, the average number of days to surgery following non-guided injection was 317.7 versus 333.7 days in the image-guided group. The average cost of performing non-image-guided injections was $203 less than using ultrasound. Image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery. Future research needs to clarify the value of image-guided CMC injections in an increasingly economically conscientious health care environment.
累及拇指腕掌（CMC）关节的关节炎在成年人群中很常见。初始治疗包括皮质类固醇注射。可以在影像引导下进行注射以协助定位；然而，其临床获益尚不清楚。本回顾性研究使用 Truven Health Marketscan 研究数据库，从 2003 年至 2014 年，确定了符合 CMC 关节骨关节炎的常见国际疾病分类，第九修订版（ICD-9）代码、影像和非影像引导注射的通用程序术语（CPT）代码以及手术干预的代码的患者。从注射到随后的注射（和/或）手术的时间长度被推断出来用于确定患者。方差分析和二项逻辑回归分别用于比较连续变量并计算优势比。我们确定了 62333 名患者（68%为女性，32%为男性），平均年龄为 59.7 岁，有符合 CMC 关节炎的常见 ICD-9 诊断代码和相应的注射 CPT 代码。非引导注射治疗的患者首次和第二次注射之间的平均天数为 237.3 天，而影像引导注射为 266.7 天。在 62333 名患者中，8107 名患者进行了手术治疗。在手术患者中，非引导注射后手术的平均天数为 317.7 天，而影像引导组为 333.7 天。非影像引导注射的平均费用比使用超声少 203 美元。影像引导拇指 CMC 注射不会显著增加注射之间的时间间隔，也不会导致手术延迟。在日益注重经济的医疗保健环境下，未来的研究需要阐明影像引导 CMC 注射的价值。
