Abstract：
BACKGROUND: Cervical articular process joint (CAPJ) therapy is advocated for horses with neck disorders. Several ultrasound-guided CAPJ techniques have been described in cadaver studies with 72%-89% intra-articular injection accuracy; however, the CAPJ injection accuracy in clinical equine practice has not been extensively reported.
OBJECTIVE: To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlargement on injection accuracy.
METHODS: Retrospective case study.
METHODS: Medical records of adult horses in which ultrasound-guided caudal (C4-T1) CAPJ injections were performed using a modified cranial approach between November 2006 and December 2020 were reviewed. Radiographic images of caudal cervical vertebrae were assessed by a blinded radiologist and the degree of CAPJ enlargement was graded using a previously described grading system (Rgrade 1-5b). Ultrasound-guided caudal CAPJ injection accuracy was determined by synovial fluid retrieval during an individual CAPJ injection. Statistical analysis was performed using mixed-effects multivariable logistic model to evaluate the association of CAPJ injection accuracy and the CAPJ injection location, Rgrade, laterality (right, left), and operator.
RESULTS: The study included 149 horses with 177 hospital admissions. Synovial fluid was obtained from 586/658 (89.1%) caudal CAPJs using modified cranial ultrasound-guided approach for CAPJ injections. C6-C7 CAPJ injections had 7-fold higher likelihood (OR = 6.78, 95% CI: 1.67-27.52; p = 0.007) of synovial fluid retrieval compared with C4-C5 CAPJ injections. Operator, CAPJ injection side (left, right), and degree of radiographic CAPJ enlargement did not have significant effects on the success of synovial fluid retrieval from ultrasound-guided caudal CAPJ injections.
CONCLUSIONS: Retrospective study design.
CONCLUSIONS: Intra-articular ultrasound-guided caudal CAPJ injections using a modified cranial approach can be performed accurately in live horses with and without CAPJ arthropathy.
摘要 背景: 开始提倡颈椎关节突关节(CAPJ)治疗用于马的颈部疾病。几种超声引导的CAPJ技术已经在尸体研究中宣称有72‐89%的关节内注射准确率，但是临床活马实践中的CAPJ注射准确率尚未有广泛报道。. 目的: 描述一种改进的前侧入路，用于超声引导下的尾侧CAPJ注射，研究这种CAPJ注射技术在活马体内的准确性，并评估CAPJ注射位置、侧边、操作人员和影像学CAPJ扩大对注射精度的影响。. 研究设计: 回顾性案例研究. 方法: 回顾了2006年11月至2020年12月间，采用改良前侧入路对成年马进行超声引导尾侧(C4‐T1) CAPJ注射的医疗记录。由盲态放射科医师核查评估椎骨尾侧的影像学图像，并使用先前描述的分级系统(Rgrade 1‐5b)对CAPJ扩大程度进行分级。超声引导的尾侧CAPJ注射准确性是通过单个CAPJ注射时的滑液回流来确定。采用混合效应多变量logistic模型进行统计分析，评估CAPJ注射准确率与CAPJ注射位置、Rgrade、侧边度(右、左)和操作者之间的关系。. 结果: 这项研究包括了149匹马及177个住院病例。采用改良前侧超声引导入路对尾侧CAPJ进行注射，其中586/658(89.1%)有滑液回流。C6‐C7的CAPJ注射与C4‐C5注射CAPJ相比，准确率/滑液回流可能性高7倍(OR = 6.78， 95% CI: 1.67–27.52；p = 0.007)。操作人员、CAPJ注射侧(左、右)和x线片CAPJ扩大程度对超声引导下尾侧CAPJ注射滑液成功回流无显著影响。. 主要局限性: 回顾性研究设计. 结论: 超声引导下经改良前侧入路的尾侧CAPJ关节内注射可以准确地用于有或没有CAPJ关节病的活马。.
OBJECTIVE: To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlargement on injection accuracy.
METHODS: Retrospective case study.
METHODS: Medical records of adult horses in which ultrasound-guided caudal (C4-T1) CAPJ injections were performed using a modified cranial approach between November 2006 and December 2020 were reviewed. Radiographic images of caudal cervical vertebrae were assessed by a blinded radiologist and the degree of CAPJ enlargement was graded using a previously described grading system (Rgrade 1-5b). Ultrasound-guided caudal CAPJ injection accuracy was determined by synovial fluid retrieval during an individual CAPJ injection. Statistical analysis was performed using mixed-effects multivariable logistic model to evaluate the association of CAPJ injection accuracy and the CAPJ injection location, Rgrade, laterality (right, left), and operator.
RESULTS: The study included 149 horses with 177 hospital admissions. Synovial fluid was obtained from 586/658 (89.1%) caudal CAPJs using modified cranial ultrasound-guided approach for CAPJ injections. C6-C7 CAPJ injections had 7-fold higher likelihood (OR = 6.78, 95% CI: 1.67-27.52; p = 0.007) of synovial fluid retrieval compared with C4-C5 CAPJ injections. Operator, CAPJ injection side (left, right), and degree of radiographic CAPJ enlargement did not have significant effects on the success of synovial fluid retrieval from ultrasound-guided caudal CAPJ injections.
CONCLUSIONS: Retrospective study design.
CONCLUSIONS: Intra-articular ultrasound-guided caudal CAPJ injections using a modified cranial approach can be performed accurately in live horses with and without CAPJ arthropathy.
摘要 背景: 开始提倡颈椎关节突关节(CAPJ)治疗用于马的颈部疾病。几种超声引导的CAPJ技术已经在尸体研究中宣称有72‐89%的关节内注射准确率，但是临床活马实践中的CAPJ注射准确率尚未有广泛报道。. 目的: 描述一种改进的前侧入路，用于超声引导下的尾侧CAPJ注射，研究这种CAPJ注射技术在活马体内的准确性，并评估CAPJ注射位置、侧边、操作人员和影像学CAPJ扩大对注射精度的影响。. 研究设计: 回顾性案例研究. 方法: 回顾了2006年11月至2020年12月间，采用改良前侧入路对成年马进行超声引导尾侧(C4‐T1) CAPJ注射的医疗记录。由盲态放射科医师核查评估椎骨尾侧的影像学图像，并使用先前描述的分级系统(Rgrade 1‐5b)对CAPJ扩大程度进行分级。超声引导的尾侧CAPJ注射准确性是通过单个CAPJ注射时的滑液回流来确定。采用混合效应多变量logistic模型进行统计分析，评估CAPJ注射准确率与CAPJ注射位置、Rgrade、侧边度(右、左)和操作者之间的关系。. 结果: 这项研究包括了149匹马及177个住院病例。采用改良前侧超声引导入路对尾侧CAPJ进行注射，其中586/658(89.1%)有滑液回流。C6‐C7的CAPJ注射与C4‐C5注射CAPJ相比，准确率/滑液回流可能性高7倍(OR = 6.78， 95% CI: 1.67–27.52；p = 0.007)。操作人员、CAPJ注射侧(左、右)和x线片CAPJ扩大程度对超声引导下尾侧CAPJ注射滑液成功回流无显著影响。. 主要局限性: 回顾性研究设计. 结论: 超声引导下经改良前侧入路的尾侧CAPJ关节内注射可以准确地用于有或没有CAPJ关节病的活马。.
摘要：
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