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关节注射

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关节注射
超音波导引髋关节注射英语Ultrasound-guided hip joint injection:皮肤标记用于标示最佳的进针点[1]

医学上,关节注射(英语:Joint injection)或关节内注射(英语:Intra-articular injection)是用来治疗关节部位发炎性疾病的一种处置,比如类风湿性关节炎干癣性关节炎痛风肌腱炎滑囊炎腕隧道症候群[2],偶尔用于骨关节炎[3][4]。将皮下注射针头插入患部关节,注入一次剂量的一种抗炎性药物,最常见的是皮质类固醇玻尿酸由于其高黏度,有时可用来取代滑囊液,注入关节作为补充[4]。这个技术也可用于从关节中抽走过多的关节液[3]

用于骨关节炎的疗效

用于骨关节炎的病患,关节注射糖皮质素(例如氢羟肾上腺皮质素)可短期舒缓疼痛,持续时间约几周到几个月之间[5]。与安慰剂相比,玻尿酸注射液对关节炎没有助益[6][7],但会增加后续疼痛的风险[6]。用于骨关节炎,相关证据尚不充足[8]高浓度血小板血浆的注射效果尚不明朗,有些研究认为可以改善功能,但不能改善疼痛,并且会增加风险[9][10]

2015年的考科蓝文献回顾发现膝关节内注射皮质类固醇不能改善生活品质,并且对膝关节间隙没有帮助,由于其研究品质较差,无法确定其注射后1至6周的临床效果[11]。2015年的另一项研究报导了高剂量关节内注射皮质类固醇的不良反应[12],2017年的一项试验,每12周注射去炎松持续2年,与安慰剂相比,发现会减少软骨厚度[13]。2018年的研究发现关节内注射去炎松与眼压升高有关[14]

超音波导引

肌肉骨骼的标准介入程序包括回顾先前的医学影像检查、病患知情同意、适当的局部麻醉。通常建议使用高频(大于 10 MHz)线形阵列超音波探头,有时可能需要低频曲线阵列探头以观察深层结构。超音波诊断检查可能包括穿刺区域的彩色超音波,对于确认邻近神经血管结构的关系十分重要[1]

举例:超音波导引髋关节注射英语Ultrasound-guided hip joint injection

参考文献

  1. ^ 1.0 1.1 Initially largely copied from: Yeap, Phey Ming; Robinson, Philip. Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin. Journal of the Belgian Society of Radiology. 2017, 101 (S2): 6. ISSN 2514-8281. PMC 6251072可免费查阅. PMID 30498802. doi:10.5334/jbr-btr.1371. 
    Creative Commons Attribution 4.0 International License (CC-BY 4.0)页面存档备份,存于互联网档案馆
  2. ^ Carpal Tunnel Review. JohnDRhoads. 25 July 2013 [25 July 2013]. (原始内容存档于30 July 2013). 
  3. ^ 3.0 3.1 intraarticular injection - definition. TheFreeDictionary.com. Farlex. 2010 [9 June 2010]. (原始内容存档于2017-02-02). 
  4. ^ 4.0 4.1 Wen, Dennis Y. Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis. American Academy of Family Physicians. 1 August 2000 [9 June 2010]. (原始内容存档于2011-06-24). 
  5. ^ Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. April 2004, 328 (7444): 869. PMC 387479可免费查阅. PMID 15039276. doi:10.1136/bmj.38039.573970.7C. 
  6. ^ 6.0 6.1 Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Annals of Internal Medicine. August 2012, 157 (3): 180–91. PMID 22868835. doi:10.7326/0003-4819-157-3-201208070-00473. 
  7. ^ Jevsevar D, Donnelly P, Brown GA, Cummins DS. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence. The Journal of Bone and Joint Surgery. American Volume. December 2015, 97 (24): 2047–60. PMID 26677239. doi:10.2106/jbjs.n.00743. 
  8. ^ Witteveen AG, Hofstad CJ, Kerkhoffs GM. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. The Cochrane Database of Systematic Reviews. October 2015, 10 (10): CD010643. PMID 26475434. doi:10.1002/14651858.CD010643.pub2. It is unclear if there is a benefit or harm for HA as treatment for ankle OA 
  9. ^ Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. December 2013, 29 (12): 2037–48. PMID 24286802. doi:10.1016/j.arthro.2013.09.006. 
  10. ^ Rodriguez-Merchan EC. Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis. The Archives of Bone and Joint Surgery. September 2013, 1 (1): 5–8. PMC 4151401可免费查阅. PMID 25207275. 
  11. ^ Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Intra-articular corticosteroid for knee osteoarthritis (PDF). The Cochrane Database of Systematic Reviews. October 2015, (10): CD005328 [2020-01-24]. PMID 26490760. doi:10.1002/14651858.CD005328.pub3. (原始内容存档 (PDF)于2021-03-21). 
  12. ^ Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthopaedic Journal of Sports Medicine. May 2015, 3 (5): 2325967115581163. PMC 4622344可免费查阅. PMID 26674652. doi:10.1177/2325967115581163. 
  13. ^ McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. May 2017, 317 (19): 1967–1975. PMC 5815012可免费查阅. PMID 28510679. doi:10.1001/jama.2017.5283. 
  14. ^ Taliaferro K, Crawford A, Jabara J, Lynch J, Jung E, Zvirbulis R, Banka T. Intraocular Pressure Increases After Intraarticular Knee Injection With Triamcinolone but Not Hyaluronic Acid (Epub abstract ahead of print). Clinical Orthopaedics and Related Research (Level-II therapeutic study). 9 March 2018, 476 (7): 1420–1425 [8 April 2018]. ISSN 1528-1132. LCCN 53007647. OCLC 01554937. PMC 6437574可免费查阅. PMID 29533245. doi:10.1007/s11999.0000000000000261 –通过ResearchGate.