Department of Orthopaedics, Woodend General Hospital, Eday Road, Aberdeen, AB15 6XS, UK.
Department of Orthopaedics, Woodend General Hospital, Eday Road, Aberdeen, AB15 6XS, UK.
Surgeon. 2021 Oct;19(5):e103-e106. doi: 10.1016/j.surge.2020.08.010. Epub 2020 Sep 23.
Caudal epidural injection (CEI) is a commonly used procedure to treat back and leg pain secondary to nerve root irritation, predominantly in the context of spinal canal stenosis. Key to a successful outcome is correct needle placement. Although fluoroscopic guidance confirms accurate needle placement, it does not help in determining the starting point, which can lead to multiple needle insertions.
This study aimed to determine the variability in size and position of the sacral hiatus and to identify reproducible surface landmarks to locate its position.
250 human sacral bones were examined, measuring morphology and structure. Vernier callipers accurate to 0.1 mm were used for measurements. Results were analysed using SPSS statistical software.
Two specimens were excluded due to agenesis of the hiatus (0.8%). Of the remaining 248 specimens, it was found that the mean internal diameter of the sacral hiatus was 5.12 mm (SD 1.61). The position of the hiatus was variable but was most commonly found at the level of the fourth sacral vertebrae (62.9%, n = 156). Mean distance between the two superolateral sacral prominences was 64.15 mm (SD 6.5) and between superolateral sacral prominences (left and right) and apex of the hiatus were 63.21 mm (SD 10.9) and 63.34 mm (SD 10.87) respectively.
Although there is a clear anatomical variance in the position and size of the sacral hiatus, this study suggests that surface anatomy landmarks can be used to form an equilateral triangle of which the inferior apex should correspond to the sacral hiatus. Knowledge of this surface anatomy may assist the correct location of the sacral hiatus and hence subsequently improve the efficacy of CEI.
骶管硬膜外注射（CEI）是一种常用于治疗神经根刺激引起的背痛和腿痛的方法，主要用于椎管狭窄的情况。成功的关键是正确的针头放置。虽然荧光镜引导可以确认准确的针头位置，但它并不能帮助确定起始点，这可能导致多次插入针头。
本研究旨在确定骶骨裂孔的大小和位置的可变性，并确定可重复的体表标志来定位其位置。
检查了 250 个人类骶骨，测量了形态和结构。使用精度为 0.1 毫米的游标卡尺进行测量。使用 SPSS 统计软件分析结果。
由于裂孔缺失（0.8%），有两个标本被排除在外。在剩余的 248 个标本中，发现骶骨裂孔的平均内径为 5.12 毫米（SD 1.61）。裂孔的位置是可变的，但最常见的是在第四骶椎水平（62.9%，n=156）。两个最外侧骶骨突起之间的平均距离为 64.15 毫米（SD 6.5），最外侧骶骨突起（左、右）与裂孔顶点之间的距离分别为 63.21 毫米（SD 10.9）和 63.34 毫米（SD 10.87）。
尽管骶骨裂孔的位置和大小存在明显的解剖变异，但本研究表明，体表解剖标志可以用来形成一个等边三角形，其下顶点应与骶骨裂孔相对应。了解这种体表解剖结构可能有助于正确定位骶骨裂孔，从而提高 CEI 的疗效。
