Department of Emergency Medicine, Medical University of South Carolina, USA.
Department of Emergency Medicine, Medical University of South Carolina, USA.
Am J Emerg Med. 2023 Sep;71:157-162. doi: 10.1016/j.ajem.2023.06.044. Epub 2023 Jun 28.
Knee arthrocentesis can be performed by landmark (LM) or ultrasound (US) guidance. The goal of performing knee arthrocentesis is to obtain synovial fluid, however, it is also important to consider the number of attempts required and accidental bone contacts that occur. This study evaluates procedural success without bone contact in knee arthrocentesis and compares both LM and US guided techniques in a cadaver model.
This was a randomized crossover study comparing US vs LM guidance for arthrocentesis in a single academic center. Volunteers were randomized to perform both LM and US guided knee arthrocentesis on cadavers. The primary outcome was procedural success, defined as first attempt aspiration of synovial fluid without bone contact. Secondary outcomes included number of attempts, number of bone contacts, time to aspiration, and confidence.
Sixty-one participants completed the study with a total of 122 procedures performed. Procedural success without bone contact was greater in the US group (84% vs 64% p = 0.02). Time to aspiration was longer for US (38.75 s vs 25.54 s p = 0.004). Participants were more confident with US compared to LM both before the procedure on a Visual Analog Scale from 1 to 100 (29 vs 21 p = 0.03) as well as after the procedure (83 vs 69 p = 0.0001). Participants had a greater median increase in confidence with US following training (44 vs 26 p = 0.01).
Study participants had greater procedural success without bone contact when US guidance was used. The increase in confidence following training was greater for US guidance than the LM method. Use of US guidance may offer a benefit by allowing for better needle control and avoidance of sensitive structures for clinicians performing knee arthrocentesis.
膝关节穿刺可以通过体表标志（LM）或超声（US）引导来进行。膝关节穿刺的目的是获取滑液，然而，考虑到所需的尝试次数和意外的骨接触也很重要。本研究评估了无骨接触膝关节穿刺的程序成功率，并在尸体模型中比较了 LM 和 US 引导技术。
这是一项在单一学术中心进行的比较 US 与 LM 引导膝关节穿刺的随机交叉研究。志愿者被随机分配在尸体上进行 LM 和 US 引导的膝关节穿刺。主要结果是程序成功率，定义为首次尝试抽吸滑液而无骨接触。次要结果包括尝试次数、骨接触次数、抽吸时间和信心。
61 名参与者完成了这项研究，总共进行了 122 次操作。US 组无骨接触的程序成功率更高（84%比 64%，p=0.02）。US 的抽吸时间更长（38.75 秒比 25.54 秒，p=0.004）。与 LM 相比，参与者在 1 到 100 的视觉模拟量表上对 US 的术前信心更高（29 比 21，p=0.03），以及术后（83 比 69，p=0.0001）。与 LM 相比，US 组在培训后信心的中位数增加幅度更大（44 比 26，p=0.01）。
当使用 US 引导时，研究参与者的无骨接触程序成功率更高。与 LM 方法相比，US 引导的信心增加幅度更大。对于进行膝关节穿刺的临床医生来说，US 引导可能通过更好地控制针头和避免敏感结构提供益处。
