Schmerzlos Zentrum, Linz, Austria.
CHAIR of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Centre, Medical University of Graz, Graz, Austria.
Pain Med. 2019 Oct 1;20(10):1890-1897. doi: 10.1093/pm/pnz059.
Given the unacceptably high miss rates of non-image-guided injections into the sacroiliac joint, either fluoroscopy or ultrasound is recommended for guidance. The real success rate of both techniques was assessed by cadaver dissection.
Twenty bodies donated to science (40 joints: 15 female and 5 male) were investigated bilaterally. Fluoroscopy and a lower ultrasound-guided approach were performed in 10 bodies each. Conditions during puncture, the subjective feeling of the needle being intra-articular, and, for fluoroscopic guidance, the intra-articular spread of the contrast were assessed. First, 0.5 cc of Iopamidol was injected, followed by 2 mL of red-colored latex. The spread was investigated by dissection via anterior opening of the sacroiliac joint and the dorsal ligaments.
Ultrasound guidance was used in 1/20 (5%, 95% CI = 0.9-23.6%) intra-articular injections. In 19/20 (95%, 95% CI = 0.9-23.6%) cases, latex spread in the interosseous sacroiliac ligament was used. Conditions of structural visibility were classified as good in 11/20 (55%, 95% CI = 34.2-74.2%) cases, puncture condition as good in 16/20 (80%, 95% CI = 58.4-91.9%) cases, and subjective feeling of the needle being intra-articular was present in 10/20 (50%, 95% CI = 34.2-74.2%) cases. Fluoroscopy showed an intra-articular injection in 10/20 (50%, 95% CI = 34.2-74.2%) cases. The structure visibility in fluoroscopy was good in 9/20 (45%, 95% CI = 25.8-65.8%), puncture conditions good in 8/20 (40%, 95% CI = 21.9-61.3%), intra-articular contrast spread visible in 10/20 (50%, 95% CI = 34.2-74.2%), and subjective feeling of being intra-articular was present in 17/20 (85%, 95% CI = 64.0-94.8%) cases.
Fluoroscopy clearly showed a higher success rate of intra-articular sacroiliac joint injection.
鉴于非影像引导下经皮骶髂关节注射的高漏诊率，推荐使用透视或超声进行引导。本研究通过尸体解剖评估了这两种技术的实际成功率。
20 具捐赠给科学的尸体（40 个关节：15 名女性和 5 名男性）进行了双侧研究。10 具尸体各进行了透视和较低超声引导下的操作。评估了穿刺过程中的条件、针进入关节内的主观感觉以及透视引导下对比剂在关节内的扩散情况。首先，注射 0.5 cc 的碘帕醇，然后注射 2 ml 红色乳胶。通过经前路切开骶髂关节和背侧韧带进行解剖来研究乳胶的扩散情况。
超声引导下有 1/20（5%，95%CI=0.9-23.6%）关节内注射。在 19/20（95%，95%CI=0.9-23.6%）例中，乳胶在骶髂骨间韧带中扩散。11/20（55%，95%CI=34.2-74.2%）例结构可视性良好，16/20（80%，95%CI=58.4-91.9%）例穿刺条件良好，10/20（50%，95%CI=34.2-74.2%）例有针进入关节内的主观感觉。透视显示 10/20（50%，95%CI=34.2-74.2%）例关节内注射。透视下结构可视性良好 9/20（45%，95%CI=25.8-65.8%），穿刺条件良好 8/20（40%，95%CI=21.9-61.3%），10/20（50%，95%CI=34.2-74.2%）例关节内对比剂扩散可见，17/20（85%，95%CI=64.0-94.8%）例有针进入关节内的主观感觉。
透视明显显示出更高的骶髂关节内注射成功率。
