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Accuracy of Needle Placement in Cadavers: Non-Guided Versus Ultrasound-Guided

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주제분류재활의학

초록

Objective To compare the accuracy rates of non-guided vs. ultrasound-guided needle placement in four lower limb muscles (tibialis posterior, peroneus longus, and short and long heads of the biceps femoris).Methods Two electromyographers examined the four muscles in each of eight lower limbs from four fresh frozen cadavers. Each electromyographer injected an assigned dye into each targeted muscle in a lower limb twice (once without guidance, another under ultrasound guidance). Therefore, four injections were done in each muscle of one lower limb. All injections were performed by two electromyographers using 18 gauge 1.5 inch or 24 gauge 2.4 inch needles to place 0.5 mL of colored acryl solution into the target muscles. The third person was blinded to the injection technique and dissected the lower limbs and determined injection accuracy. Results A 71.9% accuracy rate was achieved by blind needle placement vs. 96.9% accuracy with ultrasound-guided needle placement (p=0.001). Blind needle placement accuracy ranged from 50% to 93.8%.Conclusion Ultrasound guidance produced superior accuracy compared with that of blind needle placement in most muscles. Clinicians should consider ultrasound guidance to optimize needle placement in these muscles, particularly the tibialis posterior.

Abstract

Objective To compare the accuracy rates of non-guided vs. ultrasound-guided needle placement in four lower limb muscles (tibialis posterior, peroneus longus, and short and long heads of the biceps femoris).Methods Two electromyographers examined the four muscles in each of eight lower limbs from four fresh frozen cadavers. Each electromyographer injected an assigned dye into each targeted muscle in a lower limb twice (once without guidance, another under ultrasound guidance). Therefore, four injections were done in each muscle of one lower limb. All injections were performed by two electromyographers using 18 gauge 1.5 inch or 24 gauge 2.4 inch needles to place 0.5 mL of colored acryl solution into the target muscles. The third person was blinded to the injection technique and dissected the lower limbs and determined injection accuracy. Results A 71.9% accuracy rate was achieved by blind needle placement vs. 96.9% accuracy with ultrasound-guided needle placement (p=0.001). Blind needle placement accuracy ranged from 50% to 93.8%.Conclusion Ultrasound guidance produced superior accuracy compared with that of blind needle placement in most muscles. Clinicians should consider ultrasound guidance to optimize needle placement in these muscles, particularly the tibialis posterior.

참고문헌 (11)

  1. Boon AJ, "Accuracy of electromyography needle placement in cadavers: non-guided vs. ultrasound guided", Muscle Nerve, 44, pp.45~49 (2011)
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  3. 조강희, "견봉하 삼각근하 점액낭 주사 시 맹검 접근법과 초음파 하 접근법의 비교", Annals of Rehabilitation Medicine, 34(2), pp.209~213 (2010), 대한재활의학회
  4. Smith J, "Ultrasound-guided piriformis injection: technique description and verification", Arch Phys Med Rehabil, 87, pp.1664~1667 (2006)
  5. Boon AJ, "Ultrasoundguided needle EMG of the diaphragm: technique description and case report", Muscle Nerve, 38, pp.1623~1626 (2008)
  6. Perotto AO, "Anatomical guide for the electromyographer:the limbs and trunk" (2005), Charles C Thomas
  7. Preston DC, "Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations" (2005), Butterworth-Heinemann
  8. Schnitzler A, "Manual needle placement: accuracy of botulinum toxin A injections", Muscle Nerve, 46, pp.531~534 (2012)
  9. Rha DW, "Needle insertion into the tibialis posterior: ultrasonographic evaluation of an anterior approach", Arch Phys Med Rehabil, 91, pp.283~287 (2010)
  10. Semple R, "Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies", J Foot Ankle Res, 2, pp.24~ (2009)
  11. Yang SN, "Needle electrode insertion into the tibialis posterior: a comparison of the anterior and posterior approaches", Arch Phys Med Rehabil, 89, pp.1816~1818 (2008)

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