A Randomized Controlled Trial Evaluating the Cost-Effectiveness of Sonographic Guidance for Intra-Articular Injection of the Osteoarthritic Knee

被引:63
作者
Sibbitt, Wilmer L., Jr. [1 ]
Band, Philip A. [2 ,3 ]
Kettwich, Lawrence G. [1 ]
Chavez-Chiang, Natalia R. [1 ]
DeLea, Suzanne L. [1 ]
Bankhurst, Arthur D. [1 ]
机构
[1] Univ New Mexico, Hlth Sci Ctr, Div Rheumatol, Dept Internal Med, Albuquerque, NM 87131 USA
[2] NYU, Med Ctr, Dept Orthopaed Surg, New York, NY 10016 USA
[3] NYU, Med Ctr, Dept Pharmacol, New York, NY 10016 USA
关键词
sonography; ultrasound; injection; corticosteroid; intra-articular; outcome; osteoarthritis; RECIPROCATING PROCEDURE DEVICE; RHEUMATOID-ARTHRITIS PATIENTS; REDUCING MEDICAL DEVICES; HEALTH-CARE COSTS; CORTICOSTEROID INJECTION; NEEDLE PLACEMENT; DOUBLE-BLIND; MUSCULOSKELETAL ULTRASOUND; INFLAMMATORY ARTHRITIS; GUIDED INJECTION;
D O I
10.1097/RHU.0b013e31823a49a4
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Objective: The present randomized controlled study investigated whether sonographic needle guidance affected the outcomes of intra-articular injection for osteoarthritis of the knee. Methods: Ninety-four noneffusive knees with osteoarthritis were randomized to injection by conventional palpation-guided anatomic landmark injection or sonographic image-guided injection enhanced with a 1-handed mechanical (the reciprocating procedure device) syringe. After intra-articular placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected with the second syringe through the indwelling intra-articular needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined. Results: Relative to conventional palpation-guided anatomic landmark methods, sonographic guidance for injection of the knee resulted in 48% reduction in procedural pain (P < 0.001), a 42% reduction in pain scores at outcome (P < 0.03), 107% increase in the responder rate (P < 0.001), 52% reduction in the nonresponder rate (P < 0.001), a 36% increase in therapeutic duration (P = 0.01), a 13% reduction ($17) in cost per patient per year, and a 58% ($224) reduction in cost per responder per year for a hospital outpatient (P < 0.001). Conclusions: Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.
引用
收藏
页码:409 / 415
页数:7
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