TWI675647B - Ultrasonic guidance of subacromial bursa - Google Patents

Abstract

A method of ultrasound guidance, mainly in a unique posture, plus moderate compression of the elbow joint on the other side of the patient, can make the acromion bursa easier to develop under ultrasound, and can be used in the superior spinal muscle The needle is inserted proximally under the long axis of the tendon; due to the unique posture, the acupressure fluid can be drained from the acromion and the ultrasonic probe is moved near the large humerus nodule under the sagittal plane. Suction; that is, through the technical means of this case, the inner tubercle of the humerus can be reached to prevent the scapula from blocking the development of the acromion.

Description

Ultrasonic guidance method

The invention relates to an ultrasonic guidance method, which provides a unique posture method (Su Ci method) to allow an ultrasonic probe to keep close to and parallel to the screen of an ultrasonic machine when the ultrasonic equipment displays. plane), according to the position displayed by the ultrasound equipment, the physician can use a proximal needle to suck the fluid in the acromion sac or inject analgesics; due to the unique posture of the case, the physician and the patient can be examined. During the process, a comfortable sitting position is maintained, and the large humerus nodules are extremely internally rotated, which makes the acromion bursa easy to develop and will not be blocked by the lower edge of the scapula. The effusion can be drained by the posture and the physician can smoothly pump the effusion.

The injection of acromion bursa 1 under skeletal muscle ultrasound guidance is a widely used technique in recent years; its main purpose is to aspirate fluid from the acromion bursa 1 or inject an injection with analgesic effect on the acromion bursa 1 , Can reduce the severe pain caused by the shoulder.

Figure 1 shows the structure of the acromion bursa 1. The acromion bursa 1 is located between the scapula 2 and the humerus nodule 3. In order to detect the position of the acromion bursa 1, the doctor will ask the patient as Figure, Attachment Figure 1 The waist insert handle is placed on the hip ( modified Crass position, put the money in your pocket ) method. After detecting the position with the ultrasonic equipment, the acupuncture can be passed through the injection needle or the shoulder peak. Fluid suction.

However, in the clinical practice, the patient often finds the following problems in the course of the acromion bursa 1 detection and injection or aspiration with the waist inserted.

(1) The acromion bursa 1 is easily obscured by the acromion or the humerus nodule 3, which leads to a limited allowable needle insertion angle and is prone to puncture the humerus nodule.

(2) In the injection or suction, it can be divided into two types: distal needle or proximal needle. In terms of distal needle (such as Figure 2 in the annex), the conventional detection method requires the patient to shrink his neck and needle. Insert the needle slightly upwards. This position will cause awkwardness and uncomfortable sitting between the doctor and the patient. The distal needle is inserted from the bottom to the top, and the range is relatively narrow (about the angle of the needle is less than 10 °). The large humerus nodule 3 blocks the needle insertion direction, and it is easy to insert into the humerus nodule 3 too deeply. If the angle of the needle is too shallow, it cannot reach the deltoid muscle.

(3) As shown in Figure 3 of the appendix, the proximal needle is inserted from the top to the bottom, which is easily blocked by the bones at the lower edge of the scapula 2 and it is difficult to insert the needle. The angle of the needle is inevitably steep, and the ultrasound probe It is not easy for the needle to develop.

(4) As shown in Fig. 2 and Fig. 1 of the attachment, the method of placing the waist and placing the hand on the hip ( modified Crass position ) also causes the patient and the physician to be quite fatigued during the process of testing or injecting the needle.

(5) The posture of using a waist-inserted hand on the hip cannot achieve the effect of draining the effusion (see Figure 4 in the annex), which will cause the physician to interpret the data incorrectly without suctioning the effusion under the display of the ultrasound equipment, which will cause the disease. The patient still feels uncomfortable after visiting the doctor.

The main purpose of the present invention is to provide an ultrasonic guidance method, which provides a unique positioning method (Su Ci method) so that the ultrasonic probe can keep parallel to the screen of the ultrasonic machine when it is displayed by the ultrasonic probe. The songraphic coronal plane provides the physician with the most comfortable position for needle insertion, making the acromion bursa easy to develop.

A secondary object of the present invention is to provide an ultrasonic guidance, a unique posture (Su Ci method), which can concentrate the effusion in the acromion descending sac (due to the large humerus nodule tilting downward for drainage) effect) the acromion sac fluid) to facilitate the physician to aspirate fluid from the proximal needle.

Yet another object of the present invention is to provide an ultrasonic guidance. The unique posture (Su Ci method) allows the humerus (Humerus) to rotate extremely within 180 degrees when injected into a needle. In this space, only the deltoid muscle allows the injection of the needle to be quite smooth, and the lower edge of the scapula (Crossed empty can position) will not obscure the acromion bursa and make it easier to develop.

The ultrasonic guidance method that can achieve the above purpose includes the following steps: (1) flattening and straightening the hand; (2) palms facing down and arms turning toward the abdomen; (3) holding the other hand on the rotating side Elbow; (4) moved to the sagittal plane near a large humerus nodule through the probe of an ultrasonic device; (5) displayed a shoulder acupressure bursa on a ultrasonic device monitor.

This case extends a method of applying ultrasound guidance and injection: (1) applying the aforementioned ultrasound guidance method; (2) placing an injection needle under the long axis of the superior spinal muscle tendon Proximal needle.

Through the above technical means, this case can obtain the following advantages:

(1) With the unique Su Ci method guided by ultrasound, patients do not need to shrink their necks, and doctors do not need to bend to perform the test; in other words, the patient and the doctor are in the most comfortable condition. Perform ultrasonic detection and guide the position of the acromion bursa.

(2) The unique acuity (Su Ci method) is used to detect the acromion bursa by ultrasonic equipment. The effusion in the acromion bursa is concentrated and the ultrasound equipment accurately develops, which can help physicians quickly determine whether to suck. Effusion.

(3) The unique posture (Su Ci method) can prevent the bones at the lower edge of the scapula from blocking the acromion sac, and when the needle is inserted, the needle is inserted from the proximal side of the superior spinal muscle tendon, with high accuracy, and It allows doctors to be quite comfortable during the operation, to perform acromicular bursa injection, to avoid the injection needle inserted into the bone or not reaching the position of the acromicular bursa.

(4) Another feature of this case is that it is quite effective for the treatment of superior spinous muscle calcification inflammation. The injection of the acromion bursa is performed under the sonographic coronal plane of the ultrasonic machine, which makes the acromion bursa slightly expand so that The needle is easy to fine-tune the angle inside the acromion, and then fenestration is performed for the calcified lesion.

1‧‧‧ acromion

2‧‧‧ scapula

3‧‧‧ Great Humps

A‧‧‧hand

A1‧‧‧ Palm

B‧‧‧hand

SP‧‧‧ sagittal plane

Figure 1 is a structural diagram of the acromion bursa.

Figure 2 is a schematic diagram of the operation of a modified Crass position .

Fig. 3 is a schematic diagram (1) of the operation of the ultrasonic guidance method of the present invention, which shows a state in which a patient's hand is straightened.

Fig. 4 is a schematic diagram (2) of the operation of the ultrasonic guidance method of the present invention, which shows the state of the patient's rotating arm.

Fig. 5 is an operation schematic diagram (3) of the ultrasonic guidance method of the present invention, which shows that the patient grasps the other hand on the elbow on the rotating side.

Attached Figure 1 is the actual operation diagram of conventional technology.

Attachment Figure 2 is a schematic diagram of distal needle insertion of the modified technique ( modified Crass position ).

Attachment Figure 3 is a schematic diagram of the proximal needle insertion of a modified Crass position .

Attachment Figure 4 shows the developed state of the acromion bursa under the ultrasonic equipment using conventional technology ( modified Crass position ). The acromion bursa is about 0.4 cm thick and cannot collect effusion.

Figure 5 of the appendix is a schematic diagram of the actual use of the case. Both the doctor and the patient can maintain a comfortable sitting position for testing.

Fig. 6 of the annex shows the development state of the unique posture (Su Ci method) of the case under the ultrasonic equipment, wherein the thickness of the acromion sac is about 0.98 cm, and the effusion can be pumped.

Figure 7 of the appendix is a schematic diagram of the proximal needle insertion under the sagittal plane in this case.

Fig. 8 of the appendix is an ultrasonic image of the case in aspiration fluid.

Fig. 9 of the appendix is an ultrasound image of the effusion after aspiration of the case.

Figure 10 of the appendix is a schematic diagram of the needle insertion angle in this case.

Figures 11 to 15 of the appendix are schematic diagrams of the application of this case in the treatment of supracandeal tendon calcification inflammation.

Please refer to Figs. 3 to 5 and Figs. 5 and 6 of the attachment. The ultrasonic guidance method of the present invention mainly includes: Step 1: As shown in Fig. 3, flatten and straighten hand A; Step 2: As shown in Fig. 4 As shown in the figure, the palm A1 is facing outwards, and the arms are turned toward the abdomen; Step 3: As shown in Figure 5, hold the other hand B to the elbow or elbow joint of the rotating side hand A (crossed empty can position) Step 4: As shown in Figures 5 and 6 of the annex, move it through a probe of an ultrasonic device to a sagittal plane near the large humerus nodule 3 (the component symbol below the sagittal plane is represented by SP); Step 5: As shown in the annex As shown in FIGS. 5 and 6, a shoulder bursa 1 is displayed on a display by the probe of the ultrasonic device.

Through the above steps and methods, the implementation of this case is shown in Figure 5 of the annex. During the test, the doctor and the patient can maintain the normal sitting position to perform the acromion bursa 1 test. Because the patient's scapula 2 and humerus are large Nodules 3 all show internal adduction, so that the probe of the ultrasonic equipment can accurately detect the position of the acromion bursa 1. In addition, in this case's unique posture, the patient can concentrate the fluid accumulation (posture drainage pooling effect) on the acromion and sac 1. Therefore, after ultrasonic detection, The acromion bursa 1 can be accurately displayed on a display. The physician can accurately determine whether to draw the effusion under the measurement of the ultrasound equipment. Generally speaking, the effusion is less than 0.5 cm. Aspiration fluid is collected. The technology provided in this case can collect and aspirate fluid.

In the above embodiment, if it is not convenient for the patient to rotate the arm, the posture can also be achieved by the following method. Similarly, first straighten hand A, then rotate the body toward the arm, and then catch with the other hand B Shake your elbows to reach the positions shown in Figures 3 to 5 and Figures 5 and 6 of the accessories.

Please refer to FIG. 6 to FIG. 10 of the appendix. In this case, an injection method can be further derived through the above-mentioned ultrasonic guidance method, which includes: (1) applying the aforementioned ultrasonic guidance method; (2) placing an injection needle from the spine The needle is inserted proximally under the long axis of the muscle tendon, and the ultrasonic probe is moved under the sagittal plane SP, which can smoothly draw fluid from the acromion bursa 1 outside the humeral nodule 3.

Please continue to refer to FIG. 6 to FIG. 9 of the appendix. In this embodiment, the acupressure of the acromion bursa 1 is mainly suctioned. As shown in FIG. 6 of the annex, the acromion bursa 1 can be accumulated in a unique posture. Fluid, the fluid in the acromion bursa 1 in the attached figure 6 is about 0.98 cm, and the fluid can be suctioned. As shown in the attached figure 7, the physician can enter the spine from the proximal side of the superior spinal muscle tendon through the injection needle. Needle, and the ultrasonic probe is moved to the sagittal plane SP, as shown in Figure 6 of the annex, the injection needle will not be blocked by the scapula 2 during the needle insertion, which is relatively easy to insert. The physician can fine-tune the needle according to the position of the effusion. The angle, as shown in Figures 7 and 8 of the appendix, is the process of aspirating the effusion. The doctor gradually draws out the effusion of the acromion bursa 1 and when the effusion is withdrawn, the acromion bursa 1 will gradually return to the original Size; if attached As shown in Figure 9, the state of the acromion bursa 1 after the fluid has been completely drawn out can reduce the patient's pain. Of course, injections such as analgesics can be injected into the acromion bursa 1 to reduce pain. And increase recovery speed.

As shown in Figure 10 of the appendix, since the scapula 2 and the humerus nodule 3 will not obstruct the direction and position of the needle through the technology of the present case, the technology provided by the present invention can generally allow the angle of the needle from 15 ° or more. Compared with the traditional technical doctors who need to enter the needle from less than 10 °, the technology of the present invention can reduce the difficulty of the doctor to insert the needle, and can handle the patient's uncomfortable place.

As shown in Figures 5 to 10 of the appendix, through the technology of this case, when the physician moves the ultrasonic probe to the sagittal plane SP, the ultrasonic probe is parallel to the screen of the monitor, and the physician can more specifically target the effusion. Suction.

As shown in Figure 11 to Figure 15 of the appendix, another feature of this case is that it is quite effective for the treatment of Calcifying tendonitis of SST. The shoulder is performed in the songraphic coronal plane of the ultrasound machine. The injection of the peak bursa, which slightly expands the acromion bursa, makes it easy for the needle to fine-tune the angle within the acromion bursa (as shown in Figure 11 to Figure 14), and then open and close the window for the calcified lesion (see Appendix Figure 15).

In summary, the technology of the present invention has not been seen in books or published, and it meets the requirements of the invention patent application. I urge the Bureau to make a clear reference and grant the patent as soon as possible.

For those who need to be clear, the above is the technical principle that is immediately applied to the specific implementation of the present invention. If the changes made according to the concept of the present invention still have functions that do not exceed the spirit covered by the description and drawings, All should be within the scope of the present invention and shared by Chen Ming.

Claims (2)

An ultrasonic guidance method mainly includes: step 1: flattening and straightening the hand; step 2: palms facing down, arms rotating toward the abdomen; step 3: catching the other hand on the elbow on the rotating side; Step 4: Move the probe of an ultrasonic device to the sagittal plane near a large humerus tuberosity; Step 5: Use a probe of the ultrasonic device to display a shoulder peak sac on a display. According to the ultrasonic guidance method according to item 1 of the scope of patent application, when the ultrasonic probe is moved to the sagittal plane, the ultrasonic probe is kept parallel to the screen of the display.