骶髂关节未经影像学引导下穿刺的解剖学基础
Anatomy basis of unguided sacroiliac joint puncture
目的 为临床骶髂关节未经影像学引导下穿刺的可行性和安全性提供解剖学基础。 方法 对3例已固定好的骶髂关节断层标本，4例干燥骨盆(男女各2例)，4例防腐骨盆（男3例，女1例）和62例强直性脊柱炎患者（男32例，女30例）骶髂关节CT平扫图及三维重建进行解剖观察和测量，以髂后上棘下的骶髂关节矢状滑膜部为穿刺目标。 结果 男女矢状滑膜部矢状长度分别为（18.40±3.40）mm 和（17.32±3.60）mm（P>0.05）；男女矢状滑膜部到后正中线的距离分别为（41.00±3.30)mm和（42.74±4.00)mm（P<0.05）；男女矢状滑膜部中点与髂后上棘距离分别为（27.66±3.10)mm和（28.76±3.50)mm（P>0.05）。 结论 根据性别，脂肪厚度等不同情况在距离后正中线（41.00±3.50）mm的范围，髂后上棘下（28.00±3.20） mm这一区域进行未经引导下穿刺可使穿刺较容易进入骶髂关节，使得穿刺成功率提高。
Objective To provide anatomic basis for the feasibility and safety of unguided sacroiliac joint puncture. Methods 3 sacroiliac joint section specimens, 4 dried pelvic specimens (2 male, 2 female) , 4 antiseptic cadaveric pelvic specimens (3 male.1 female) and 62 ankylosing spondylitis patients' sacroiliac joint CT imaging data were collected and measured. The injection target was designated at the sagittal synovium part below the posterior superior iliac spine. Results The average length of sagittal synovium part was about（18.40±3.40）mm in male and （17.32±3.60）mm in female(P>0.05); The average distance between the posterior midline and sagittal synovium part was （41.00±3.30）mm in male and （42.74±4.00）mm in female(P<0.05), with the significant difference; The average distance between the midpoint and posterior superior iliac spine was（27.66±3.10)mm in male and （28.76±3.50）mm in female respectively(P>0.05). Conclusions According to the sex and thickness of fat, conducting injection in the area of （41.00±3.50）mm away from the posterior midline, （28.00±3.20）mm from the posterior superior iliac spine makes puncture entering the sacroiliac joint more accurately, easily, and successfully.
Sacroiliac joint / Unguided puncture / Sagittal synovium part
[1] 中华医学会风湿病学分会. 强直性脊柱炎诊治指南(草案)
[J].中华风湿病学杂志, 2003, 7 ( 10 ): 641-644.
[2] Van Der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis- a proposal for modification of the New York criteria
[J].Arthritis Rheum, 1984, 27 ( 4): 361-368.
[3] Dreyfuss P, Dreyer S, Cole A, et al. Sacroiliac joint pain
[J]. Am Acad Orthop Surg, 2004,12(2):55-65.
[4] Cohen S. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment
[J]. Anesth Analg ,2005,101(14):40-53.
[5] Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain
[J]. Spine, 1995, 20(1):31-37.
[6] Boswell MV, Shah RV, Everett CR, et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines
[J]. Pain Physician, 2005, 8(1):1-47.
[7] Forst SL, Wheeler MT, Fortin JD,et al. The sacroiliac joint: anatomy, physiology and clinical significance
[J]. Pain Physician, 2006(1):9:61-67.
[8] Stallmeyer MJ, Ortiz AO. Facet blocks and sacroiliac joint injections
[J]. Tech Vasc Interv Radiol, 2002, 5(4):201-206.
[9] 黄永火,孙向前,周庭勇,等. 骶髂关节解剖特点与X线表现的分析
[J]. 中国影像学技术, 2001,17(4):372-374.
[10]Drake RL, Vogl W, Mitchell AW. Gray's Anatomy for Student
[M]. Singapore: Elsevier Pte Ptd, 2005:385.
[11] Rosatelli AL, Agur AM, Chhaya S. Anatomy of the interosseous region of the sacroiliac joint
[J]. J Orthop Sports Phys Ther, 2006,36(4):200-208
[12] 张英琦,李义凯,付小勇,等. 骶髂关节的放射解剖学观测
[J]. 中国临床解剖学杂志,2009, 27(1):73-75.
[13] 杜心如,张一模,顾少光,等. 臀中皮神经的形态特点及其与臀骶部痛的关
[J].中国临床解剖学杂志,1996,14(3):190-192.
[14] 陈肃标,曾庆馀,刘源,等. 骶髂关节穿刺的断层解剖研究
[J].中华风湿病学杂志,2001,5(4):237-239.
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