Bagoji Ishwar B, Bharatha Ambadasu, Prakash K G, Hadimani Gavishiddappa A, Desai Vikas, Bulgoud R S
Department of Anatomy, SRI B.M. Patil Medical College, BLDE (deemed to be University), Vijayapur, Karnataka, India.
Faculty of Medical Sciences, University of The West Indies, Cave Hill Campus, Barbados, West Indies.
Maedica (Bucur). 2020 Dec;15(4):468-476. doi: 10.26574/maedica.2020.15.4.468.
The knowledge of sacral hiatus anatomy is crucial in clinical situations requiring caudal epidural block for various diagnostic and therapeutic procedures of the lumbosacral spine to avoid complications and failure rate. This study was undertaken to compare morphometric characteristics of sacral hiatus in human dry sacra and pelvic radiographs for placing the needle more accurately in the sacral hiatus landmarks to permit correct, painless, and uncomplicated caudal epidural accesses. The present study was done on 138 human adult dry sacra and 110 anteroposterior lumbosacral spine radiographs of the North Karnataka region of India. Sacral hiatus was evaluated in each sacrum based on its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior diameter at its apex, and transverse width at its base. The mean length of sacral hiatus in men and women was 27.81+1.17 mm and 24.73+2.21 mm, respectively. The mean anteroposterior diameter of the sacral hiatus at the apex was 6.24+2.73 mm in males and 6.63+2.81 mm in females. The transverse width of the sacral hiatus at the base was 17.56+1.81 mm in males and 17.92+2.59 mm in females. The location of the apex of sacral hiatus was the highest in number at the level of the fourth sacral vertebra (23.63%). The location of apex in radiographs of all lumbosacral spine S3 showed 49.09% maximum. The location of the base of the sacral hiatus was observed in the dry sacra at the level of the fifth sacral vertebra (64.54%). In the present study, different shapes of the sacral hiatus were recorded. The most common shape in males and females was inverted U shape (42.02%), followed by inverted V shape (26.08%) and dumbbell shape (12.31%). The least common shape was observed in the bifid sacra (5.07%). In 2.17% of cases, sacral hiatus was absent. Percentage of absence, agenesis, irregular, and bifid shapes were found rather in female than male sacra. An anteroposterior view of spine radiograph showed sacral hiatus agenesis in both females (7.81%) and males (4.34%). The anatomical knowledge of sacral hiatus and its variations are important in caudal epidural anesthesia, and it may improve the success rate of caudal epidural anesthesia.
在需要进行骶管硬膜外阻滞以对腰骶椎进行各种诊断和治疗程序的临床情况下，了解骶管裂孔的解剖结构对于避免并发症和降低失败率至关重要。本研究旨在比较人类干燥骶骨和骨盆X线片中骶管裂孔的形态测量特征，以便更准确地将穿刺针置于骶管裂孔标志处，从而实现正确、无痛且无并发症的骶管硬膜外穿刺。本研究对印度北卡纳塔克邦地区的138块成人干燥骶骨和110张腰骶椎前后位X线片进行了研究。根据骶管裂孔的形状、顶端水平、根据骶骨和尾椎确定的底部、长度、顶端的前后径以及底部的横向宽度，对每块骶骨中的骶管裂孔进行评估。男性和女性骶管裂孔的平均长度分别为27.81 + 1.17毫米和24.73 + 2.21毫米。男性骶管裂孔顶端的平均前后径为6.24 + 2.73毫米，女性为6.63 + 2.81毫米。男性骶管裂孔底部的横向宽度为17.56 + 1.81毫米，女性为17.92 + 2.59毫米。骶管裂孔顶端位置数量最多的是在第四骶椎水平（23.63%）。在所有腰骶椎S3的X线片中，顶端位置最多的占49.09%。在干燥骶骨中观察到骶管裂孔底部位于第五骶椎水平（64.54%）。在本研究中，记录了骶管裂孔的不同形状。男性和女性中最常见的形状是倒U形（42.02%），其次是倒V形（26.08%）和哑铃形（12.31%）。最不常见的形状见于骶骨裂（5.07%）。在2.17%的病例中，骶管裂孔缺失。发现骶管裂孔缺失、发育不全、不规则和骶骨裂形状的比例在女性骶骨中高于男性。脊柱X线片的前后位显示女性（7.81%）和男性（4.34%）均有骶管裂孔发育不全。骶管裂孔的解剖知识及其变异在骶管硬膜外麻醉中很重要，可能会提高骶管硬膜外麻醉的成功率。
