Cho Chul-Hyun, Min Byung-Woo, Bae Ki-Cheor, Lee Kyung-Jae, Kim Du Hwan
Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Keimyung University, Daegu, South Korea.
Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
Bone Joint J. 2021 Feb;103-B(2):353-359. doi: 10.1302/0301-620X.103B2.BJJ-2020-0755.R1.
Ultrasound (US)-guided injections are widely used in patients with conditions of the shoulder in order to improve their accuracy. However, the clinical efficacy of US-guided injections compared with blind injections remains controversial. The aim of this study was to compare the accuracy and efficacy of US-guided compared with blind corticosteroid injections into the glenohumeral joint in patients with primary frozen shoulder (FS).
Intra-articular corticosteroid injections were administered to 90 patients primary FS, who were randomly assigned to either an US-guided (n = 45) or a blind technique (n = 45), by a shoulder specialist. Immediately after injection, fluoroscopic images were obtained to assess the accuracy of the injection. The outcome was assessed using a visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV) and range of movement (ROM) for all patients at the time of presentation and at three, six, and 12 weeks after injection.
The accuracy of injection in the US and blind groups was 100% (45/45) and 71.1% (32/45), respectively; this difference was significant (p < 0.001). Both groups had significant improvements in VAS pain score, ASES score, SSV, forward flexion, abduction, external rotation, and internal rotation throughout follow-up until 12 weeks after injection (all p < 0.001). There were no significant differences between the VAS pain scores, the ASES score, the SSV and all ROMs between the two groups at the time points assessed (all p > 0.05). No injection-related adverse effects were noted in either group.
We found no significant differences in pain and functional outcomes between the two groups, although an US-guided injection was associated with greater accuracy. Considering that it is both costly and time-consuming, an US-guided intra-articular injection of corticosteroid seems not always to be necessary in the treatment of FS as it gives similar outcomes as a blind injection. Cite this article: 2021;103-B(2):353-359.
超声（US）引导下注射广泛应用于肩部疾病患者，以提高注射准确性。然而，与盲目注射相比，US引导下注射的临床疗效仍存在争议。本研究的目的是比较US引导下与盲目注射糖皮质激素至原发性冻结肩（FS）患者盂肱关节的准确性和疗效。
90例原发性FS患者接受关节内糖皮质激素注射，由一名肩部专家将其随机分为US引导组（n = 45）或盲目注射组（n = 45）。注射后立即获取荧光透视图像以评估注射准确性。在所有患者就诊时以及注射后3周、6周和12周，使用视觉模拟评分法（VAS）评估疼痛、美国肩肘外科医师（ASES）评分、主观肩关节值（SSV）和活动范围（ROM）。
US组和盲目组的注射准确率分别为100%（45/45）和71.1%（32/45）；差异有统计学意义（p < 0.001）。两组在注射后直至12周的整个随访过程中，VAS疼痛评分、ASES评分、SSV、前屈、外展、外旋和内旋均有显著改善（均p < 0.001）。在评估的时间点，两组之间的VAS疼痛评分、ASES评分、SSV和所有ROM均无显著差异（均p > 0.05）。两组均未观察到与注射相关的不良反应。
我们发现两组之间在疼痛和功能结局方面无显著差异，尽管US引导下注射的准确性更高。考虑到其成本高且耗时，在FS治疗中，US引导下关节内注射糖皮质激素似乎并非总是必要的，因为其结果与盲目注射相似。引用本文：2021;103 - B(2):353 - 359。
