Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan.
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
Pain Med. 2017 Sep 1;18(9):1642-1648. doi: 10.1093/pm/pnw297.
Sacroiliac intraarticular injection is necessary to confirm sacroiliac joint (SIJ) pain and is usually performed via the caudal one-third portion of the joint. However, this is occasionally impossible for anatomical reasons, and the success rate is low in clinical settings. We describe a technique via the middle portion of the joint.
Observational study.
Enrolled were 69 consecutive patients (27 men and 42 women, with an average age of 53 years) in whom the middle portion of 100 joints was targeted.
With the patient lying prone-oblique with the painful side down, a spinal needle was inserted into the middle portion of the joint. Subsequently, the fluoroscopy tube was angled at a caudal tilt of 25-30° to clearly detect the recess between the ilium and sacrum and the needle depth and direction. When the needle reached the posterior joint line, 2% lidocaine was injected after the contrast medium outlined the joint.
The success rate of the injection method was 80% (80/100). Among 80 successful cases, four were previously unsuccessful when the conventional method was used. Intraarticular injection using the new technique was unsuccessful in 20 joints; in three of these cases, the conventional method proved successful, and no techniques were successful in the other 17 cases.
The injection technique via the middle portion of the joint can overcome some of the difficulties of the conventional injection method and can improve the chances of successful intraarticular injection.
骶髂关节腔内注射对于确认骶髂关节（SIJ）疼痛是必要的，通常通过关节的尾三分之一部分进行。然而，由于解剖原因，这偶尔是不可能的，并且在临床环境中的成功率较低。我们描述了一种通过关节中部进行的技术。
观察性研究。
连续纳入 69 例患者（27 名男性和 42 名女性，平均年龄 53 岁），其中 100 个关节的中部有 100 个关节。
患者取俯卧斜位，疼痛侧朝下，将脊柱针插入关节中部。然后，将荧光透视管倾斜 25-30°的尾倾角度，以清晰显示髂骨和骶骨之间的凹陷以及针的深度和方向。当针到达后关节线时，在造影剂勾勒出关节后，注入 2%利多卡因。
注射方法的成功率为 80%（80/100）。在 80 例成功病例中，有 4 例先前使用常规方法时不成功。20 个关节采用新技术进行关节内注射失败；其中 3 例采用常规方法成功，另外 17 例则没有任何技术成功。
通过关节中部进行的注射技术可以克服常规注射方法的一些困难，并提高关节内注射成功的机会。
