关于改良Nevaiser入路进行盂肱关节穿刺准确性探析.docVIP

关于改良Nevaiser入路进行盂肱关节穿刺准确性探析 　【摘要】 ［目的］探讨非引导下改良Nevaiser入路行肱关节腔穿刺的准确性及安全性。［方法］对90例盂肱关节腔造影患者，根据其ID号进行简单随机分组,分别采用改良Nevaiser入路、前方入路、后方入路行盂肱关节腔穿刺45、20、25例，并注射造影剂；比较3种方法造影剂显影位置并计算穿刺成功率，观察各组不良反应及并发症。［结果］改良Nevaiser入路、前方入路和后方入路穿刺成功率分别为91.1%、50%、76%。前方入路组5例（25％）术后穿刺部位出现持续疼痛且＞4 h；3组穿刺术后均未出现并发症。［结论］改良Nevaiser穿刺入路成功率高、安全可靠、患者依从性好，值得推广。 【关键词】 改良Nevaiser入路； 盂肱关节； 穿刺； 准确性 Abstract：［Objective］To evaluate the accuracy of glenohumeral joint intra-articular injection without any guidance through modified Nevaiser approach. ［Method］Ninety patients were randomly devided into three groups. Each group received injections of constrast medium without any guidance through one of the three approach: anterior, posterior and modified Nevaiser portal. The accuracy of each approach was by the location of constrast medium and the patients’ postoperative condition of different approach was compared defermined, and the accuracy of glenohumeral injection through modified Nevaiser approach were evaluated. ［Result］Accuracy rates of three approach were as follows: anterior 50% (n=20), posterior 76% (n=25), and modified Nevaiser approach 91.1% (n=45). Of all patients, 5 (25％) were patients from anterior approach group complained of servere pain (gt;24 h) with VAS ranging from 5-9 points. There was no occurrence of severe complications such as infection or shoulder malfunction. ［Conclusion］The technique of glenohumeral joint injection without any guidance through modified Nevaiser approach is highly accurate. No complication was noted. This thechnique be widely used in glenohumeral joint injection. Key words：modified nevaiser approach； glenohumeral joint； injection； accuracy 盂肱关节腔穿刺术是一项广泛运用的临床操作技术，它既是一种治疗手段，又是一种有效的诊断方法。目前常用的穿刺入路包括：经关节腔前方、前下方、前上方及关节腔后方入路［1～4］，其中，最常采用的非引导下穿刺入路为经前方及后方入路。前方有很多重要结构，穿刺并发症多,后方穿刺成功率低。1987年，Nevaiser采用一种新的肩关节镜手术入路，位于肩锁关节内后侧、肩峰内侧及肩胛冈前侧区域，即Nevaiser关节镜入路。作者将Nevaiser关节镜入路穿刺点外移，正对盂肱关节上方，初步观察较原入路穿刺点成功率高。 1 资料与方法 1.1 一般资料 　　本组共90例患者接受盂肱关节造影，其中男52例（15～72岁），女38例（27～66岁）。本组患者根据其ID号进行简单随