Oo Win Min, Linklater James, Siddiq Md Abu Bakar, Fu Kai, Hunter David J
Department of Physical Medicine and Rehabilitation, Mandalay General Hospital University of Medicine Mandalay Myanmar.
Rheumatology Department, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia.
Australas J Ultrasound Med. 2024 Apr 19;27(2):97-105. doi: 10.1002/ajum.12386. eCollection 2024 May.
More than half of the patients with moderate and severe osteoarthritis (OA) report unsatisfactory pain relief, requiring consideration of intra-articular (IA) injections as the second-line management. Ultrasound-guided IA injection has proven evidence of higher accuracy in administering IA injectates into the joints than landmark-guided or blind IA injections. However, questions remain about translating higher accuracy rates of ultrasound-guided injection into better clinical improvements. Therefore, we examined the symptomatic benefits (pain, function and patient satisfaction) of ultrasound-guided injection in knee, hip and hand OA compared with blind injections by synthesising a systematic review and meta-analysis of randomised controlled trials (RCT).
PubMed, Medline and Embase databases were searched for eligible studies from their inception to August 28, 2023.
Out of 295 records, our meta-analysis included four RCTs (338 patients with knee OA), demonstrating significant improvement in procedural pain [-0.89 (95% CI -1.25, -0.53)], pain at follow-up [-0.51 (95% CI -0.98, -0.04)] and function [1.30 (95% CI 0.86, 1.73)], favouring ultrasound guidance. One single study showed higher patient satisfaction with ultrasound guidance.
Ultrasound-guided IA injection provided superior clinical outcomes compared with landmark-guided IA injection.
超过半数的中重度骨关节炎（OA）患者报告疼痛缓解效果不理想，需要考虑将关节内（IA）注射作为二线治疗方法。与基于体表标志的注射或盲法IA注射相比，超声引导下的IA注射已被证明在将IA注射剂注入关节方面具有更高的准确性。然而，关于如何将超声引导注射的更高准确率转化为更好的临床改善效果，仍存在疑问。因此，我们通过对随机对照试验（RCT）进行系统评价和荟萃分析，比较了超声引导注射与盲法注射在膝、髋和手部OA中的症状改善情况（疼痛、功能和患者满意度）。
检索了PubMed、Medline和Embase数据库，以查找从数据库建立到2023年8月28日的符合条件的研究。
在295条记录中，我们的荟萃分析纳入了4项RCT（338例膝骨关节炎患者），结果显示在操作疼痛[-0.89（95%CI -1.25，-0.53）]、随访时疼痛[-0.51（95%CI -0.98，-0.04）]和功能[1.30（95%CI 0.86，1.73）]方面有显著改善，支持超声引导。一项单独的研究显示超声引导下患者满意度更高。
与基于体表标志的IA注射相比，超声引导下的IA注射提供了更好的临床结果。
