Babaei-Ghazani Arash, Forogh Bijan, Raissi Gholam Reza, Ahadi Tannaz, Eftekharsadat Bina, Yousefi Naseh, Rahimi-Dehgolan Shahram, Moradi Katayoun
Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran.
Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran.
J Pain Res. 2020 Jun 26;13:1569-1578. doi: 10.2147/JPR.S248600. eCollection 2020.
To compare two common approaches for ultrasonography (US)-guided injection.
Sixty patients with mild-to-moderate CTS were included in this double-blind randomized controlled trial (RCT). They received a single shot of corticosteroid injection through either the US-guided in-plane approach: radial or ulnar side. Participants were evaluated using Boston Carpal Tunnel Questionnaire (BCTQ) and visual analogue scale (VAS) for pain, as well as electrodiagnosis (EDX) and US parameters before the intervention, and within 12 weeks of follow-up.
In both groups, all outcomes, except for the electrodiagnostic measures, significantly improved within the follow-up. Pain-VAS and both subscales of BCTQ questionnaire, as our main subjective outcomes, revealed dramatic improvement, with the largest amount of changes in VAS (70%; comparing to baseline value), and about 37% for both of BQSS and BQFS scales, all indicating superiority of radial to ulnar in-plane approach. During the first follow-up, we did not detect any remarkable preference between the groups in either subjective or electrodiagnostic variables. However, there was a significant difference at next follow-up time-points in terms of VAS for pain and BQFS favoring radial approach (Table 3). Furthermore, US-measured parameters including nerve-circumference and CSA improved only in the radial in-plane group.
The current data proved that radial in-plane approach for CTS injection could be at least as effective as the more common ulnar in-plane method. Even the pain-relief effect was longer for the radial in-plane approach. Also, patients' functional status and objective variables all revealed better outcomes via the new approach.
比较两种常用的超声（US）引导下注射方法。
本双盲随机对照试验（RCT）纳入了60例轻至中度腕管综合征（CTS）患者。他们通过US引导的平面内进针方法：桡侧或尺侧，接受了单次皮质类固醇注射。在干预前以及随访的12周内，使用波士顿腕管问卷（BCTQ）和视觉模拟量表（VAS）评估疼痛，以及进行电诊断（EDX）和US参数评估。
在两组中，除电诊断指标外，所有结局在随访期间均有显著改善。作为主要主观结局的疼痛VAS以及BCTQ问卷的两个子量表均显示出显著改善，VAS变化最大（与基线值相比为70%），BQSS和BQFS量表均约为37%，所有这些均表明桡侧平面内进针方法优于尺侧。在首次随访期间，我们在主观或电诊断变量方面未发现两组之间有任何明显偏好。然而，在下一个随访时间点，在疼痛VAS和BQFS方面存在显著差异，支持桡侧进针方法（表3）。此外，包括神经周长和横截面积（CSA）在内的US测量参数仅在桡侧平面内组有所改善。
目前的数据证明，CTS注射的桡侧平面内进针方法至少与更常用的尺侧平面内方法一样有效。甚至桡侧平面内进针方法的止痛效果持续时间更长。而且，通过新方法，患者的功能状态和客观变量均显示出更好的结果。
