Kissling R O
Orthopädische Universitätsklinik Balgrist, Zürich.
Z Rheumatol. 1992 Jul-Aug;51(4):183-7.
We anatomically dissected four pelvic bones without damaging any ligaments, and tried to find a dorsal approach to arthrograph the sacroiliac joint. The joint could not be punctured through its proximal two-thirds: on the one hand, because of its overall angulated orientation, on the other hand, because of the significant overhang of the spina iliaca posterior superior, medially, and the impossibility to make further needle corrections through the very strong ligaments. The only possible approach was situated one finger's width medially to the spina iliaca posterior inferior, with the needle directed laterally at an angle of 20 degrees to the horizontal. Only 0.1-0.2 ml of contrast fluid could be injected. The arthrographic information was reduced to only determining the form of the joint; the state of the cartilage and integrity of the capsule could not be assessed. The best image exposure had to be determined individually and for each case under fluoroscopy, with, unfortunately, a certain level of irradiation. In vivo, the puncture of the lower third of the joint is impossible; the concept of "intraarticular injection of the sacroiliac joint" must be abandoned, as this joint can hardly be punctured dorsally.
我们对四块骨盆骨进行了解剖，未损伤任何韧带，并试图找到一种经背部入路对骶髂关节进行关节造影。关节的近端三分之二无法穿刺：一方面是因为其整体呈角状的方向，另一方面是由于髂后上棘在内侧有明显的悬垂，且无法通过非常坚韧的韧带对穿刺针进行进一步调整。唯一可能的入路位于髂后下棘内侧一个手指宽度处，穿刺针与水平面呈20度角向外。只能注入0.1 - 0.2毫升造影剂。关节造影信息仅能用于确定关节的形态；无法评估软骨状态和关节囊的完整性。最佳图像曝光必须在荧光透视下针对每个病例单独确定，不幸的是，这会有一定程度的辐射。在活体中，关节下三分之一的穿刺是不可能的；“骶髂关节关节内注射”的概念必须摒弃，因为该关节很难从背部进行穿刺。
