目的 为封闭治疗肩周炎提供解剖学基础。 方法 查找封闭注射治疗肩周炎的操作方法。利用30例肩部三维重建模型，探讨骨性定位标志与病变部位的几何关系，并获得改良的封闭注射方法。用改良方法对34例防腐标本进行封闭注射，经解剖验证注射的准确性。 结果 几何关系分析发现肩峰前角进针，7号针头呈扇形注射，几乎可注入整个肩峰下间隙；在喙突尖与肩峰前角连线的中点，向肱骨头可刺入关节腔。解剖发现肱二头肌腱与大结节前缘存在一定的间隙，可为进针点。改良的注射方法准确率为100%。 结论 熟悉肩部的几何关系和解剖特点，改良的封闭注射方法有助于提高封闭注射的准确性。
Abstract
Objective To provide anatomical basis for the treatment of scapulohumeral periarthritis using the local steroid injection. Methods The literature of the injection method for the treatment of scapulohumeral periarthritis by the local steroid injection were reviewed. The geometric relationship between the bone location markers and the lesion site was investigated by using 30 shoulder of three-dimensional models, and an improved method of local steroid injection was obtained. A modified method was used to perform closed injection on 34 antiseptic cadaver specimens, and the accuracy of the injection was verified by anatomy. Results 1. The geometric relationship analysis showed that the needle was inserted into the anterior corner of the acromion, and the No.7 needle was fan-shaped, and the needle could reach almost the entire subacromial space. At the midpoint of the line between the apex of coracoid process and anterior corner of the acromion, the needle may be inserted into the joint cavity towards the humerus head. 2. Anatomically, it was found that there was a certain gap between the biceps brachii tendon and the anterior edge of greater tubercle, which could be the point of needle entry. 3. The accuracy of the improved injection method was 100%. Conclusions Familiarity with the geometric relationship and anatomical characteristics of the shoulder is helpful to improve the feasibility and accuracy of local steroid injection.
关键词
肩周炎 /
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冻结肩 /
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封闭 /
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解剖学
Key words
Scapulohumeral periarthritis /
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Frozen shoulder /
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Local steroid injection /
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Anatomy
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参考文献
[1] 李义凯. 软组织痛的基础与临床[M]. 香港: 世界医药出版社, 2011: 201-212.
[2] Hsieh LF, Lin YJ, Hsu WC, et al. Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: a randomized controlled trial[J]. Clin Rehabil, 2021, 35(9): 1305-1316. DOI: 10.1177/02692155211007799.
[3] 史可任. 颈腰关节疼痛及注射疗法(5版)[M]. 北京: 人民军医出版社, 2012: 243-284.
[4] Koraman E, Turkmen I, Uygur E, et al. Ultrasound guided multisite injection technique in the treatment of frozen shoulder[J]. Arthrosc Tech, 2022, 11(10): e1823-e1826. DOI: 10.1016/j.eats.2022.06.020.
[5] 付志俭, 宋文阁. 镇痛注射技术图解(4版)[M]. 济南: 山东科学技术出版社, 2013: 74-84.
[6] Geannette C, Williams D, Berkowitz J, et al. Ultrasound-guided biceps tendon sheath injection: spectrum of preprocedure appearances[J]. J Ultrasound Med, 2019, 38(12): 3267-3271. DOI: 10.1002/jum.15062.
[7] 贾芝和, 王盟, 何敏, 等. 封闭疗法联合蜡疗治疗肩周炎的疗效[J]. 中国老年学杂志, 2022, 42(10): 2427-2429. DOI: 10.3969/j.issn.1005-9202.2022.10.034.
[8] Sun Y, Zhang P, Liu S, et al. Intra-articular steroid injection for frozen shoulder: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis[J]. Am J Sports Med, 2017, 45(9): 2171-2179. DOI: 10.1177/0363546516669944.
[9] Kumari K, Kamal M, Singariya G, et al. Effect of epidural levobupivacaine with or without dexamethasone soaked in gelfoam for postoperative analgesia after lumbar laminectomy: a double blind, randomised, controlled trial[J]. Indian J Anaesth, 2018, 62(7): 509-515. DOI: 10.4103/ija.IJA_128_18.
[10] 金安国. 盂肱关节注射治疗压痛点不明确的冻结肩[J]. 临床骨科杂志, 2012, 15(2): 1-2. DOI: 10.3969/j.issn.1008-0287.2012.02.030.
[11] 蒋勰, 陈志超, 黄华强, 等. 不同关节腔注射方法治疗早期冻结肩疗效与安全性分析[J]. 华西医学, 2018, 33(12): 1495-1499. DOI: 10.7507/1002-0179.201811034.
[12] 解小丽, 苏圣贤, 张志刚, 等. X线直视下肩关节腔注射治疗在肩周炎中的应用[J]. 中国疼痛医学杂志, 2014, 20(9): 639-642. DOI: 10.3969/j.issn.1006-9852.2014.09.008.
[13]McGill Kevin C, Patel Rina, Chen David, et al. Ultrasound-guided bursal injections[J]. Skeletal Radiol, 2023,52(5):967-978.DOI: 10.1007/s 00256-022-04153-y.
[14] Lin CL, Yang MT, Lee YH, et al. Effect of the critical shoulder angle on the efficacy of ultrasound-guided steroid injection for subacromial bursitis[J]. J Pers Med, 2022, 12(11): 1-9. DOI: 10.3390/jpm12111879.
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