關節注射

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關節注射
Hip joint injection by anterior longitudinal approach.jpg
超音波導引髖關節注射英语Ultrasound-guided hip joint injection:皮膚標記用於標示最佳的進針點[1]

醫學上,關節注射(英語:Joint injection)或關節內注射(英語:Intra-articular injection)是用來治療關節部位發炎性疾病的一種處置,比如類風濕性關節炎乾癬性關節炎痛風肌腱炎滑囊炎腕隧道症候群[2],偶爾用於骨關節炎[3][4]。將皮下注射針頭插入患部關節,注入一次劑量的一種抗炎性藥物,最常見的是皮質類固醇玻尿酸由於其高黏度,有時可用來取代滑囊液,注入關節作為補充[4]。這個技術也可用於從關節中抽走過多的關節液[3]

用於骨關節炎的療效[编辑]

用於骨關節炎的病患,關節注射糖皮質素(例如氫羥腎上腺皮質素)可短期舒緩疼痛,持續時間約幾周到幾個月之間[5]。與安慰劑相比,玻尿酸注射液對關節炎沒有助益[6][7],但會增加後續疼痛的風險[6]。用於骨關節炎,相關證據尚不充足[8]高濃度血小板血漿的注射效果尚不明朗,有些研究認為可以改善功能,但不能改善疼痛,並且會增加風險[9][10]

2015年的考科藍文獻回顧發現膝關節內注射皮質類固醇不能改善生活品質,並且對膝關節間隙沒有幫助,由於其研究品質較差,無法確定其注射後1至6週的臨床效果[11]。2015年的另一項研究報導了高劑量關節內注射皮質類固醇的不良反應[12],2017年的一項試驗,每12周注射去炎松持續2年,與安慰劑相比,發現會減少軟骨厚度[13]。2018年的研究發現關節內注射去炎松與眼壓升高有關[14]

超音波導引[编辑]

肌肉骨骼的標準介入程序包括回顧先前的醫學影像檢查、病患知情同意、適當的局部麻醉。通常建議使用高頻(大於 10 MHz)線形陣列超音波探頭,有時可能需要低頻曲線陣列探頭以觀察深層結構。超音波診斷檢查可能包括穿刺區域的彩色超音波,對於確認鄰近神經血管結構的關係十分重要[1]

舉例:超音波導引髖關節注射英语Ultrasound-guided hip joint injection

參考文獻[编辑]

  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. PMID 30498802. doi:10.5334/jbr-btr.1371. 
    Creative Commons Attribution 4.0 International License (CC-BY 4.0)
  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]. 
  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]. 
  5. ^ Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. April 2004, 328 (7444): 869. PMC 387479. 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. 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. PMID 26490760. doi:10.1002/14651858.CD005328.pub3. 
  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. 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. 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. PMID 29533245. doi:10.1007/s11999.0000000000000261 –通过ResearchGate.