Buntragulpoontawee Montana, Chang Ke-Vin, Vitoonpong Timporn, Pornjaksawan Sineenard, Kitisak Kittipong, Saokaew Surasak, Kanchanasurakit Sukrit
Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Front Pharmacol. 2021 Mar 5;11:621150. doi: 10.3389/fphar.2020.621150. eCollection 2020.
Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety. To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment. Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described. From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study. Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.
周围神经卡压综合征通常会导致疼痛、不适以及随之而来的感觉和运动功能障碍。已经提出了许多保守治疗措施，局部注射就是其中之一。如今，借助高分辨率超声，可以可视化解剖细节，从而实现诊断和更精确的注射治疗。因此，已经开发出了超声引导注射技术，使用一系列注射剂来机械性地松解和减压受压神经，这被称为水分离术或神经周注射疗法。有几种不同的注射剂可供选择，包括生理盐水、局部麻醉剂、皮质类固醇、5%葡萄糖水溶液（D5W）和富血小板血浆（PRP），在选择药物时，在有效性和安全性方面存在临床挑战。为了系统地检索和总结不同常用注射剂用于超声引导下水分离术治疗卡压性神经病的临床证据和作用机制。对包括PubMed、EMBASE、Scopus和Cochrane在内的四个数据库进行了系统检索，检索时间从数据库建立至2020年8月22日。纳入了评估不同常用注射剂用于超声引导下水分离术治疗卡压性神经病有效性和安全性的研究。注射剂疗效表现为对疼痛强度、临床症状/功能、身体性能、电诊断结果和神经横截面积的临床影响。还描述了每种注射剂的安全性结果和作用机制。在十项超声引导下水分离术研究中，九项研究针对腕管综合征进行，一项研究针对肘部尺神经病变进行。所有研究都比较了不同的干预措施和不同的对照。注射剂包括生理盐水、D5W、皮质类固醇、局部麻醉剂、透明质酸酶和PRP。五项研究调查了PRP或PRP加夹板固定的比较。与对照组或皮质类固醇相比，D5W和PRP均显示出一致的良好结果。在使用生理盐水、局部麻醉剂或皮质类固醇注射或夹板固定的比较组中也观察到了改善的结果。未报告严重不良事件。仅一项研究报告了局部类固醇注射的副作用。超声引导下水分离术是治疗周围神经卡压的一种安全有效的方法。应根据注射剂的作用机制、有效性和安全性概况来考虑注射剂选择。
