Ultrasound as a Screening Tool for Proceeding With Caudal Epidural Injections
Ultrasound as a Screening Tool for Proceeding With Caudal Epidural Injections
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DOI：
10.1016/j.apmr.2009.11.019
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发表时间：
2010-03-01
影响因子：
4.3
通讯作者：
Tang, Simon F.
中科院分区：
文献类型：
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作者：
Chen, Carl P.;Wong, Alice M.;Tang, Simon F.
Chen CP，Wong AM，Hsu C-C，Tsai W-C，Chang C-N，Lin S-C，Huang Y-C，Chang C-H，Tang SF.超声作为进行尾部硬膜外注射的筛选工具。目的：应用超声技术研究骶管裂孔的解剖结构。基于超声：骶管裂孔的图像，骶管硬膜外注射的可行性，然后可以进行评估。设计：病例对照研究。设置：三级医疗中心的康复门诊。参与者：患者（N=47; 20名女性，27名男性）患有下背痛和坐骨神经痛的患者，他们将接受尾部硬膜外注射治疗，被招募到本研究中。所有患者均获得骶裂孔的超声图像。采用一种能实时检测肌肉骨骼组织的超声仪，测量骶裂孔前后壁的距离主要指标：骶管直径和双侧角之间的距离，单位为mm。结果：在我们招募的患者中，测量到骶管的平均直径为5.3 ± 2.0 mm。测量双侧角间的平均距离为9.7 ± 1.9mm。7例患者尾侧硬膜外注射失败。在这7例患者中，4例骶管直径非常小（1.6、1.2、1.4和1.5 mm）。在1名男性中，超声图像显示骶管裂孔闭合（无法测量骶管直径）。两名患者在将针插入骶管后检查脑脊液是否溢出时发现新鲜血液流入注射器。出于安全原因，类固醇注射没有在这2 patients.Conclusions：超声可作为一种有效的筛选工具，骶硬膜外注射。超声能清楚地观察骶裂孔的解剖变异。超声图像显示骶管闭合，骶骨直径范围为1.2 - 1.6mm，可能提示骶管硬膜外注射失败率较高。
Chen CP, Wong AM, Hsu C-C, Tsai W-C, Chang C-N, Lin S-C, Huang Y-C, Chang C-H, Tang SF. Ultrasound as a screening tool for proceeding with caudal epidural injections. Arch Phys Med Rehabil 2010;91:358-63.Objective: To study the anatomical structure of the sacral hiatus using ultrasound. Based on the sonographic: images of the sacral hiatus, the feasibility of caudal epidural injection can then be assessed.Design: Case-controlled study.Setting: Rehabilitation outpatient clinic in a tertiary medical center.Participants: Patients (N=47; 20 women, 27 men) with low back pain and sciatica who were to receive caudal epidural injection treatments were recruited into this study.Interventions: Sonographic images of the sacral hiatus were obtained from all the patients. An ultrasound machine capable of examining musculoskeletal tissues with real-time linear-array ultrasound transducer was used to measure the distance between the anterior wall and posterior wall of the sacral hiatus (diameter of the sacral hiatus) and the distance between bilateral cornua.Main Outcome Measures: Diameter of the sacral canal and distance between bilateral cornua measured in millimeters.Results: The mean diameter of the sacral canal was measured to be 5.3+/-2.0mm in our recruited patients. The mean distance between bilateral cornua was measured to be 9.7+/-1.9mm. Caudal epidural injections failed in 7 patients. In these 7 patients, 4 had very small diameter of the sacral canal (1.6, 1.2, 1.4, and 1.5mm). In 1 man, sonographic images revealed a closed sacral hiatus (no sacral canal diameter can be measured). Two patients revealed flow of fresh blood into the syringe while checking for the escape of cerebrospinal fluid after the needles were inserted into the sacral canal. For safety reasons, steroid injections were not performed in these 2 patients.Conclusions: Ultrasound may be used as an effective screening tool for caudal epidural injections. Anatomic variations of the sacral hiatus can be clearly observed using ultrasound. Sonographic images indicating a closed sacral canal and sacral diameters ranging from 1.2 to 1.6mm may suggest a higher failure rate in caudal epidural injection.