Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan.
Pain Pract. 2020 Jan;20(1):55-61. doi: 10.1111/papr.12826. Epub 2019 Aug 28.
Caudal epidural blocks often fail due to the difficulty of appropriate needle insertion. This study aimed to evaluate the anatomy of the sacral hiatus using ultrasound imaging.
This was a retrospective study involving 76 patients with spinal disorders. The following factors were analyzed to see if they affected the palpability of the sacral hiatus: sex, body mass index (BMI), and the morphology of the sacral hiatus on ultrasound imaging. The difficulty of needle insertion and the factors that influenced it were investigated in 28 of the 76 patients, who underwent landmark-based caudal epidural block procedures performed by the same doctor.
Among the 76 patients, the mean length of the sacral hiatus was 21.3 ± 5.6 mm, the mean distance from the skin to the sacral cornua was 5.2 ± 3.4 mm, and the mean angle of the sacral hiatus was 16.4 ± 5.5 degrees. Sacral base protrusion was present and absent in 35 and 41 cases, respectively. The sacral hiatus exhibited good and poor palpability in 53 and 23 cases, respectively. The mean distance from the skin to the sacral cornua and BMI were found to significantly influence the palpability of the sacral hiatus. Only sacral base protrusion significantly influenced the difficulty of needle insertion.
The mean distance from the skin to the sacral cornua and BMI were found to be associated with the palpability of the sacral hiatus, and sacral base protrusion was demonstrated to be associated with the difficulty of needle insertion into the sacral hiatus.
由于难以进行适当的针插入，尾部硬膜外阻滞经常失败。本研究旨在使用超声成像评估骶骨裂孔的解剖结构。
这是一项回顾性研究，涉及 76 例脊柱疾病患者。分析了以下因素，以确定它们是否影响骶骨裂孔的可触知性：性别、体重指数（BMI）和超声成像上的骶骨裂孔形态。在 76 例患者中的 28 例中，调查了针插入的难度及其影响因素，这些患者由同一位医生进行基于标志的尾部硬膜外阻滞程序。
在 76 例患者中，骶骨裂孔的平均长度为 21.3 ± 5.6mm，皮肤到骶骨角的平均距离为 5.2 ± 3.4mm，骶骨裂孔的平均角度为 16.4 ± 5.5 度。骶骨基底突出存在和不存在分别为 35 例和 41 例。骶骨裂孔的可触知性良好和差分别为 53 例和 23 例。皮肤到骶骨角的距离和 BMI 被发现显著影响骶骨裂孔的可触知性。只有骶骨基底突出显著影响了针插入骶骨裂孔的难度。
皮肤到骶骨角的距离和 BMI 被发现与骶骨裂孔的可触知性相关，骶骨基底突出被证明与针插入骶骨裂孔的难度相关。
