Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
Medicina (Kaunas). 2022 Apr 22;58(5):575. doi: 10.3390/medicina58050575.
: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. : This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the "Earthworm sign," the "Patch sign," the "Tubular sign" and the "Absent flow sign." The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. : We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The "Patch sign" showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The "Earthworm sign" demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The "Tubular sign" showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. : Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection.
虽然在骶管硬膜外注射中使用了超声引导技术，但如果超声无法识别血管内注射，仍可能发生严重并发症。为了在骶管硬膜外注射时确定硬膜外和血管内注射，我们在向硬膜外腔注入药物时使用了功率多普勒超声（PDU）。
这是一项回顾性研究，共纳入 2019 年 1 月至 2019 年 12 月期间 277 例难治性腰痛或退行性椎间盘患者。我们使用 PDU 检查骶管硬膜外注射的注入物流动，并通过透视确认。在我们的研究中，PDU 确定了四种流动模式：“蚯蚓征”、“斑块征”、“管状征”和“无流征”。PDU 识别硬膜外和血管内注射的准确性通过每次注射时记录的透视图像确定。
我们评估了 277 例患者（平均年龄 68.6 ± 13.2 岁；106 例男性）。“斑块征”在预测无血管内注射的硬膜外注射时，敏感性为 88.76%，特异性为 80%。“蚯蚓征”在检测血管内注射时，敏感性为 70%，特异性为 100%。“管状征”在预测成功的硬膜外注射时特异性为 100%，敏感性为 9.4%。无血流信号在预测成功的硬膜外注射时，敏感性为 1.87%，特异性为 90%。
超声引导骶管硬膜外注射在 PDU 的协助下可以准确判断硬膜外和血管内注射，因此是一种优于透视引导骶管硬膜外注射的良好替代技术。
