Hamoudi Ceyran, Martins Antoine, Debordes Pierre-Antoine, Goetsch Thibaut, Liverneaux Philippe, Facca Sybille
Department of Hand Surgery, SOS main, University hospital of Strasbourg, Strasbourg, France.
Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
J Hand Surg Glob Online. 2023 May 30;5(5):650-654. doi: 10.1016/j.jhsg.2023.04.013. eCollection 2023 Sep.
Hand-held ultrasound (HHUS) is gaining popularity among clinicians. Although its use for procedural guidance could have several advantages in hand surgery, other surgeons may wonder about its added benefits. This cadaveric study aimed to examine the hypothesis of increased accuracy of wireless HHUS-guided injections versus that of blind injections into the flexor sheath.
Our series included 20 fresh cadaveric hands with 80 fingers randomly assigned to 2 groups. In group A, 10 hands were randomly assigned to receive a landmark injection and then received a blinded injection to the flexor tendon sheath (FTS). In group B, 10 hands were blinded in the same manner and received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomic dissection was performed to evaluate the injection accuracy based on the dye's filling pattern in the FTS as stage I (no filling), stage II (<50% filling), and stage III (>50% filling). Statistical analysis was performed, and <.05 indicated a significant difference.
One finger was excluded because of severe Dupuytren contracture. In group A, 39 blind injections of the FTS were performed, with 82% (32/39) fingers achieving stage III filling. In group B, 40 ultrasound-guided FTS injections were performed, with 90% (36/40) of fingers achieving stage III filing. Our study did not reveal any superiority in accuracy when ultrasound guidance was used ( = .35).
Hand-held ultrasound-guided FTS injections were not more accurate than blind injections performed by an experienced hand surgeon. These findings suggest that blind injections can be used as routine practice when performed by experienced operators to treat trigger finger. However, the use of HHUS may offer other advantages in hand surgery practice.
Ultimately, choosing to perform HHUS-guided injection versus blind injection to treat trigger finger depends on the surgeon's experience and preference for a particular technique.
手持式超声（HHUS）在临床医生中越来越受欢迎。尽管其用于手术指导在手部手术中可能有诸多优势，但其他外科医生可能会质疑其额外的益处。本尸体研究旨在检验无线HHUS引导下注射与盲目注射到屈肌鞘相比准确性是否提高的假设。
我们的研究系列包括20只新鲜尸体手，80根手指随机分为2组。A组中，10只手被随机分配接受基于体表标志的注射，然后盲目注射到屈肌腱鞘（FTS）。B组中，10只手以相同方式进行盲法操作，并接受HHUS超声引导下的注射。注射亚甲蓝，然后进行解剖以根据染料在FTS中的填充模式评估注射准确性，分为I期（无填充）、II期（<50%填充）和III期（>50%填充）。进行了统计分析，P<0.05表示有显著差异。
1根手指因严重的杜普伊特伦挛缩被排除。A组对FTS进行了39次盲目注射，82%（32/39）的手指达到III期填充。B组进行了40次超声引导下的FTS注射，90%（36/40）的手指达到III期填充。我们的研究未发现使用超声引导时在准确性上有任何优势（P = 0.35）。
手持式超声引导下的FTS注射并不比经验丰富的手外科医生进行的盲目注射更准确。这些发现表明，由经验丰富的操作者进行盲目注射时可作为治疗扳机指的常规操作。然而，HHUS的使用在手部手术实践中可能还有其他优势。
最终，选择进行HHUS引导下注射还是盲目注射来治疗扳机指取决于外科医生的经验以及对特定技术的偏好。
