Kwon Young Suk, Lee Narea, Lee Ho Seok, Youn Eun Ji, Lee Soo Kyung, Kim Youngmi, Lee Jae Jun
Department of Anesthesiology and Pain medicine, Chuncheon Sacred Heart Hospital, College of Medicine.
Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
Medicine (Baltimore). 2020 Jul 10;99(28):e20935. doi: 10.1097/MD.0000000000020935.
During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx.Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 ('sacrum 5') and rectum, and 'sacrum 4 to 5 junction' and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint.In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males (P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint.Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.
在行奇神经节阻滞时，穿刺针可能进入骶前间隙，在骶管麻醉时可能会穿透骶骨。由于直肠位于骶尾骨前方，因此有被穿刺的风险，确定骶尾骨与直肠之间的距离以及骶尾骨的厚度很重要。使用计算机断层扫描测量直肠与骶尾骨之间的距离以及骶尾骨的厚度。测量了尾骨与直肠、骶尾关节与直肠、骶骨第5节（“骶骨5”）与直肠以及“骶骨4至5交界处”与直肠之间的距离。根据直肠内有无粪便比较结果。在骶骨4至5交界处和骶尾关节处测量骶尾骨的厚度。
本研究共纳入1264例患者。男性和女性的所有距离均小于1毫米，但男性尾骨与直肠之间的距离除外。在男性和女性中，直肠内有无粪便时骶尾骨与直肠之间的距离无显著差异，但男性骶骨5与直肠之间的距离存在差异（P = 0.048）。几名男性和女性患者在骶尾关节处的厚度小于5毫米。
一些患者骶骨与直肠之间的距离小于1毫米。从业者在将穿刺针应用于骶前间隙时应谨慎。如果在骶管阻滞期间意外穿透骶骨，则不能排除直肠穿刺的可能性。女性排便情况不影响骶尾骨与直肠之间的距离。
