超声引导下髋关节穿刺注药路径的临床应用价值：一项前瞻性随机对照研究

目的探讨超声引导下髋关节穿刺注药新路径（前上路径）的临床应用价值,并与经典路径（前下路径）进行比较。 方法自2020年10月至2021年5月在解放军总医院第一医学中心超声诊断科就诊、接受超声引导下髋关节穿刺注药治疗的108例患者,共118例髋关节纳入此前瞻性对照研究,将所有患者随机分为前上路径（穿刺针方向为髋关节前方沿股骨头长轴方向从近心端向远心端）和前下路径（穿刺针方向为髋关节前方沿股骨头长轴方向从远心端向近心端）2组,每组各59例髋关节。记录所有超声引导下髋关节穿刺注药病例的穿刺进针深度、穿刺时间、穿刺次数、调针次数、穿刺即刻疼痛视觉模拟评分量表（VAS）等相关资料,并对2组的穿刺进针深度、穿刺时间、一次穿刺成功率及穿刺即刻VAS评分等资料进行比较分析。 结果2组的一次穿刺成功率、穿刺即刻VAS评分比较,差异均无统计学意义（P=1.000、0.793）。而穿刺进针深度前上路径组［（54.2±7.8）mm］＜前下路径组［（58.8±8.3）mm］,差异有统计学意义（P=0.002）。穿刺时间前上路径组［（47.3±26.6）s］较前下路径组［（57.5±19.8）s］更短,差异有统计学意义（P=0.019）。 结论在超声引导下髋关节穿刺术的穿刺进针深度和穿刺时间方面,新路径（前上路径）优于经典路径（前下路径）。临床应根据患者的个体差异选择合适的穿刺路径,未来髋关节穿刺注药前上路径有望成为一种新的更加安全有效的超声引导下髋关节穿刺优势路径。     

超声引导下肺穿刺活检在临床的应用

目的：探讨超声引导自动活检的优势和并发症的发生情况。方法：通过对60例超声引导自动活检术，分析穿刺成功率与穿刺后并发症的发生率。结果：总的穿刺成功率高达98．3％(58／60)，穿刺成功率与病变的性质有关，穿刺取材病理诊断准确率96．9％(31／33)，并发症的发生率仅为0．13％(8／60)。结论：超声引导自动活检术是一种取材成功率高、操作简便、并发症少的组织学取材方法。     

超声评分法在强直性脊柱炎髋关节受累诊断中的应用价值

目的 探讨超声评分法诊断强直性脊柱炎髋关节受累的应用价值。方法 对86例强直性脊柱炎髋关节受累的患者分别按照髋关节囊及大转子肌腱端不同超声表现进行评分,分析髋关节超声与临床、实验室指标的相关性,评价超声评分法诊断髋痛患者的可行性。结果 ①既往髋痛病史与软骨损伤相关性最高(r＝0.509,P＜0.01);髋关节内旋和外旋疼痛与滑膜内血流相关性最高(r＝0.550,P＜0.01),与滑膜增厚和积液低度相关(r＝0.416、0.336,P＜0.01);大转子压痛与附着端血流低度相关(r＝0.475,P＜0.01)。②髋关节囊评分与VAS和ASDAS-CRP评分呈显著相关(r=0.784、0.624,P＜0.01)。结论 超声评分中髋关节囊评分与临床评分及实验室指标相关性最高,可在一定程度上应用于髋关节受累的患者,超声单个项指标中滑膜内血流最能提示疾病活动性。     

超声引导下乳腺穿刺活检的临床应用探讨

目的探讨超声引导下乳腺穿刺活检在临床中的应用价值。方法回顾性分析横沥人民医院超声检查发现乳腺实性占位性病变但不能确定病变性质的78例患者的临床资料。所有患者均行超声引导下穿刺活检,活检采用16G切割穿刺针及自动活检枪,在高频超声引导下经皮穿刺取材,所取组织送病理检查。结果 78例穿刺活检患者中病理报告良性病变62例,恶性病变16例。病例中未见并发症。结论超声引导下乳腺穿刺活检是一种简便易行的诊断方法,适合临床推广应用。     

超声评分法诊断强直性脊柱炎髋关节受累的应用价值

目的 探讨超声评分法诊断强直性脊柱炎(AS)髋关节受累的应用价值.方法 选取我院收治的AS患者86例,应用高频超声观察髋关节(包括髋关节囊和大转子肌腱端)受累的异常表现,并应用简化的超声评分法对上述异常超声表现进行评分,获得髋关节囊评分、股骨头评分、肌腱端评分及总体评分(为前3个部位评分累加).分析各超声评分与临床评分...     

经直肠超声引导精囊穿刺注药治疗精囊炎

本研究对 6 6例精囊炎患者分别采用经直肠超声引导精囊穿刺注药治疗及口服和静脉全身给药治疗 ,并对两组的疗效进行比较 ,现报告如下。资料与方法本组 6 6例 ,年龄 2 3～ 5 2岁 ,平均 34.6岁 ,根据临床症状、实验室检查及超声检查诊断为精囊炎 ,病程 1～ 3年。患者血精 2 2例 ,血尿及终末血尿 11例 ,会阴部坠胀不适、隐痛伴尿频 17例 ,性功能减退 8例 ,遗精 4例 ,不育 4例。精液镜检 :ＷＢＣ >10个 /ＨＰ 32例 ,ＲＢＣ( ～ ) 2 4例 ,ＷＢＣ >10个 /ＨＰ并ＲＢＣ( ～ ) 10例。经直肠超声示单纯精囊炎 5 9例 ,精囊炎合并囊肿 7例…     

超声引导下肾囊肿穿刺的体会

1995年 1月～ 2 0 0 0年 5月间 ,对我院门诊及住院病人用Ｂ超定位引导下行肾囊肿穿刺抽液 ,并注射无水酒精治疗 74例 ,疗效满意 ,现报告如下。1　资料和方法1 1　临床资料　本组 74例 ,男性 48人 ,女性 2 6人 ,年龄在 2 6～ 75岁 ,平均年龄 5 2 6岁。健康体检发现 11例 ,有症状 6 3例 ,为腰部酸胀不适等。囊肿直径 4 2～ 11 0ｃｍ ,单侧 6 5例 ,双侧9例 ;肾上极囊肿 12例 ,肾门旁囊肿 6例 ,其余位于中份及下极囊肿 5 6例。术前患者出凝血时间均正常。1 2　仪器与方法　使用ＨＩＴＡＣＨＩＥＵＢ- 30 5 ,ＬＯＧＩＱ - 2 0 0超声诊断仪 ,探头…     

超声引导下腹腔穿刺灌注化疗的临床应用

目的评价超声引导下腹腔灌注化疗的临床应用。方法超声引导下腹壁穿刺,腹膜外少量生理盐水注射,局部渗入腹腔后,穿刺进入腹腔,腹腔内灌注化疗药物。结果超声引导下腹腔穿刺、腹腔灌注化疗7例18人次,均顺利完成腹腔灌注化疗治疗,取得满意临床效果。结论超声引导下腹腔穿刺是实现少量或无腹水患者腹腔灌注化疗的重要手段,该方法科学、安全、简便,准确性和成功率高。     

超声引导下经皮穿刺治疗的临床应用价值

目的：探讨超声引导下经皮穿刺治疗各部位占位病变的临床应用价值。方法：对79例各部位占位性病变行超声引导下经皮穿刺治疗。其中11例为失支手术机会的癌肿病人,实行癌肿内直接注射无水乙醇和（或）抗癌药物。55例囊性肿块行穿刺抽液注入硬化剂治疗。6例梗阻性黄疸行超声引导下经皮经肝穿刺胆管引流术。8例肝脓肿行穿刺置管引流术。结果：11例手术手术机会的癌肿病人治疗后1、2年生存率分别为72.7％,45.5％。疗效肯定。55例囊性肿块治疗后随访6个月－3年,治愈率达87.0％（47／54）,总有效率100％,其中1例操作失误未完成治疗。6例阻塞性黄疸行PTBD及8例肝脓肿病人穿刺置管引流后临床症状迅速改善,疗效显著。结论：超声引导下穿刺治疗术在各部位占位性病变的治疗中有其独特的临床应用价值,值得推广。     

超声引导肾盂穿刺造影的临床应用

目的探讨超声引导肾盂穿刺造影的临床价值.方法在B超引导下对X-线尿路造影和超声显像难以确诊病因的肾盂和输尿管积水进行肾盂穿刺造影.结果本组98例超声引导肾盂穿刺造影全部成功,其中输尿管狭窄65例,包括右侧35例,左侧30例;输尿管结石15例,其中右侧8例,左侧7例;11例结核侵犯多个肾盏和输尿管,其中右侧4例、左侧3例、双侧4例;1例左输尿管先天性发育不全闭锁,闭锁部位距肾门约45 mm处;6例输尿管肿瘤侵犯,其中右侧2例,左侧4例,有92例经手术病理证实.结论对单纯X-线尿路造影和超声显像难以确诊病因的肾盂和输尿管积水,在B超引导下进行肾盂穿刺造影,可以明确诊断,弥补单独使用时的不足,在临床上值得推广应用.     

肱二头肌长头肌腱腱鞘积液对超声引导下关节腔注射治疗冻结肩疗效的影响

目的：探讨肱二头肌长头肌腱腱鞘积液对超声引导下关节腔注射治疗冻结肩疗效的影响。 方法：81例临床诊断为冻结肩的患者,根据有无肱二头肌长头肌腱腱鞘积液分为A组（合并腱鞘积液）、B组（无腱鞘积液）,所有患者行超声引导下关节腔注射治疗,并在治疗前及治疗后2周行高频超声检查获得腋下关节囊（axillary recess capsule , ARC）厚度,同时行Constant-Murley肩关节功能评分。 结果：两组患者治疗后与治疗前相比,ARC厚度均明显减少,Constant-Murley评分均明显增高（P<0.05）;A组与B组治疗后比较,A组Constant-Murley评分明显低于B组,A组ARC厚度明显高于B组（P<0.05）。 结论：肱二头肌长头肌腱腱鞘积液能够影响冻结肩超声引导下关节腔注射治疗疗效。ARC厚度能够作为冻结肩超声引导下肩关节腔注射治疗效果评价的参考指标。     

Accuracy and Feasibility of Ultrasound-Guided Intra-articular Injection of the Rat Hip Joint

Intra-articular injection is frequently used as an effective diagnostic and treatment tool for hip joint diseases. However, the underlying treatment mechanism remains unclear because of a lack of experimental animal models. A challenge facing researchers is how to accurately and consistently perform injections involving animal hip joints. The purpose of this study, then, was to establish an ultrasound (US)-guided intra-articular (IA) injection technique using rat hip joints and to evaluate its accuracy and feasibility versus a fluoroscopy (FL)-guided technique. For this study, 20 US-guided and 20 FL-guided IA injections were administered to separate groups of Sprague-Dawley rats. For each procedure, 50 μL of iohexol was injected into the hip joint using a 25G needle. The US-guided injections were performed using a linear probe, and the FL-guided IA injections were performed using C-arm X-ray fluoroscopy. All injections were verified by computed tomography imaging. The number of successful injections and needle repositions per injection, as well as operating times, were recorded, and the rats were observed for complications for 10 d after the injections. Statistical analysis was used to compare US-guided and FL-guided techniques with significance set at p < 0.05. The success rate was markedly higher for the US-guided interventions (90%) than for the FL-guided interventions (75%) (p<0.05). The intervention time was shorter in the US-guided group (95.95 ± 8.376 s) than in the FL-guided group (110.70 ± 20.236 s) (p < 0.05), and the median number of needles repositioned per injection in the US-guided group (1.20 ± 0.41) was notably less than that in the FL-guided group (1.60 ± 0.68) (p < 0.05). A puncture site hematoma was noted in two rat hips (10%) the day after injection in the FL-guided group. Overall, the study indicated that ultrasound-guided intra-articular injection of the hip is a feasible, accurate and safe method for use in rats. This makes it a promising tool for diagnosing coxofemoral pain, producing hip osteoarthritis animal models and administering intra-articular medication.     

Evaluation of Needle Positioning During Blind Intra-Articular Hip Injections for Osteoarthritis: Fluoroscopy Versus Arthrography

D?raço?lu D, Alptekin K, Dikici F, Balc? H?, Özçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.

Objective

To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA).

Design

Experimental clinical study.

Setting

Operating theater of a university hospital.

Participants

Patients (N=16) (10 women, 6 men), who were diagnosed as having OA according to the American College of Rheumatology criteria and whose radiologic grades were II or III according to Kellgren-Lawrence.

Interventions

Three bilateral and 13 unilateral hip injections were performed (3 times at 1-week intervals). After it was presumed blindly that the needle was within the joint, the location of the needle was checked with backflow technique and fluoroscopy. Entrance to the joint cavity was also ensured by reconfirmation with contrast medium, and the procedure was then terminated with hyaluronic acid injection.

Main Outcome Measures

Assessment of blind needle placement into the hip joint by using backflow technique, fluoroscopic images, and contrast enhancement.

Results

The location of the needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%) of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38 interventions, localization of the intra-articular needle could be confirmed by intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions exhibited intra-articular contrast enhancement. Backflow was not observed in 23 (79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow.

Conclusions

In light of our results, we suggest that blind injection of the osteoarthritic hip joint can be inaccurate even with careful technique. Further, the backflow method does not appear to be reliable, and guidance during the injection seems to be necessary.     

Accuracy of Sonographically Guided Intra‐articular Injections in the Native Adult Hip

Objective. The purpose of this study was to determine the accuracy of sonographically guided intra‐articular injections performed in the native adult hip using contrast‐enhanced fluoroscopy as a reference standard. Methods. Twenty‐eight consecutive patients (ages 32–91 years; mean, 68 years) referred to the pain clinic for intra‐articular hip injections were recruited to participate. In each case, a 2‐ to 6‐MHz curvilinear array transducer was used to place the needle into the hip joint at the femoral head‐neck junction using an oblique sagittal approach. A contrast‐enhanced fluoroscopic examination was then completed and assessed by an independent observer to determine needle placement accuracy. Once accurate placement was confirmed, the therapeutic injection proceeded. Results. Thirty hip injections were completed in 15 women and 13 men (1 man and 1 woman received bilateral injections). The patients' body mass index (BMI) ranged from 20 to 39 kg/cm² (mean, 28 kg/cm²) and procedure time from initial scanning to injection averaged 112 seconds (range, 47–187 seconds). Overall, 97% of sonographically placed needles were accurate. The single inaccurate placement resulted from inadvertent needle withdrawal from the joint capsule during connection of the extension tubing for contrast agent injection in a young patient with a BMI of 28 kg/cm² and no hip effusion. Conclusions. Sonographic guidance can be used to inject the native adult hip joint with acceptable accuracy. When using the oblique sagittal approach, operators must be aware of the possibility of needle withdrawal from the joint due to the limited intra‐articular space within the target region, particularly in the absence of effusion.