CT导引骶髂关节穿刺活检和注射技术的应用

CT-guided percutaneous needle biopsy and intra articular injection of sacroiliac joint

目的 评估CT导引经皮骶髂关节穿刺活检及关节内注射技术的临床应用价值。方法 研究对象为盆部标本 3具 (初期实验 )、强直性脊柱炎 (AS)患者 18例和拟诊早期AS的未分化脊柱关节病 (uSpA)患者 10例。在CT导引下 ,经臀部皮肤作双侧骶髂关节穿刺 ,2 8例患者并作滑膜部活检和注射治疗。结果 盆部标本穿刺到位率 4 / 6 ,2 8例患者穿刺到位率 96 4 % (5 4 / 5 6 )。穿刺层面距骶髂关节下缘 1 6 9cm± 0 6 3cm。活检标本获取率 88 5 % (46 / 5 4 ) ,病理检查阳性率 91 7% (2 2 / 2 4 )。AS和uSpA患者的骶髂关节见炎症改变。关节内注射治疗近期有效率为 78 6 % (2 2 / 2 8)。全组病例无并发症和副作用发生。结论 CT是骶髂关节穿刺有效、安全的导引手段。穿刺平面以骶髂关节中 1/ 3与下 1/ 3交界处为宜。对uSpA患者作骶髂关节活检有利于AS的早期诊断。骶髂关节内注射是AS和uSpA全身药物治疗的有效补充。

Objective To investigate the clinical value of CT guided percutaneous needle biopsy and intra articular injection of sacroiliac joint. Methods CT guided percutaeous puncture was conducted to the bilateral sacroiliac joints of 3 specimens of adult pelvis, 18 patients with ankylosing spondylitis (AS), and 10 patients with undifferentiated spondyloarthropathy (uSpA) suspected as early AS clinically. All 28 patients had taken non steroidal anti inflammatory agents without adequate control of symptoms or with serious side effects. Biopsy of synovium with 16G or 18G needles and intra articular injection of steroid were made to the 28 patients. Results The general success rate of puncture was 4/6 among the specimens of pelvis and was 96.4% (54/56) among the 28 patients. The level of needle insertion was 1.69 cm±0.63 cm up the lower edge of the joint. The obtainment rate of biopsy specimen was 88.5%(46/54) for the cases punctured successfully. The positive rate of pathological examination was 91.7% (22/24). Marked inflammatory changes were found in the biopsy specimens from AS patients and early inflammatory changes were found in the biopsy specimens from uSpA patients. The immediate effective rate of intra articular steroid injection was 78.6% (22/28). No complication and side effect was found. Conclusion CT guided percutaneous puncture is an effective and safe guided method for biopsy and intra articular injection of sacroiliac joint. The proper level of puncture is by the juncture of the middle 1/3 and lower 1/3 of sacroiliac joint. Needle biopsy helps early diagnosis of AS for patients with uSpA. Intra articular injection is an effective supplementary therapy for AS and uSpA patients.