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。

Clinical application value of ultrasound-guided hip puncture path: a prospective randomized controlled study

ObjectiveTo explore the clinical application value of a new path (anterior superior path) of ultrasound-guided drug injection into the hip joint, and compare it with the classical path (anterior inferior path). MethodsA total of 108 patients who were treated at the Department of Ultrasonic Diagnosis of the First Medical Center of the Chinese People's Liberation Army General Hospital from October 2020 to May 2021 were treated by intraluminal puncture and drug injection of the hip joint under the guidance of ultrasound. A total of 118 hip joints were included in the previous prospective control study. All patients were randomly divided into two groups: anterior superior path (the direction of the puncture needle was from the proximal end to the distal end of the femoral head along the long axis of the hip joint) and anterior inferior path (the direction of the puncture needle was from the distal end to the proximal end along the long axis of the femoral head). There were 59 hips in each group. The puncture depth, puncture time, puncture times, needle adjustment times, visual analogue scale (VAS) score, and other related data were recorded, and the puncture depth, puncture time, success rate of one puncture, and the outcome of immediate VAS score were compared between the two groups. ResultsThere was no significant difference in the success rate of puncture and the outcome of VAS score at the moment of puncture between the two groups (P=1.000 and 0.793, respectively). The puncture depth in the anterior superior path group (54.2±7.8) mm] was significantly less than that in the anterior inferior path group (58.8±8.3) mm; P=0.002]. The puncture time in the anterior superior path group (47.3±26.6) s] was significantly shorter than that of the anterior inferior path group (57.5±19.8) s; P=0.019]. ConclusionIn terms of puncture depth and puncture time of ultrasound-guided hip puncture, the new path (anterior superior path) is better than the classical path (anterior inferior path). Clinically, the puncture path should be selected according to the individual differences of patients. In the future, the superior path before drug injection of hip joint puncture is expected to become a new, safer, and more effective dominant path of ultrasound-guided hip joint puncture.