骶外侧动脉第一背侧支的解剖和多普勒超声探测的初步研究

Anatomy and Doppler ultrasound appearance of the first foraminal ramus of the lateral sacral artery:a preliminary study

目的旨在证实骶外侧动脉第一背侧支是骶髂关节背侧的供血动脉,应用多普勒超声探测该血管的正常血流动力学表现。方法对一具尸体进行解剖,明确骶外侧动脉第一背侧支的来源、分支及其供血区。再对50名志愿者行骶外侧动脉第一背侧支多普勒超声探测,测量其血流动力学数据,包括收缩期峰值流速(PSV)、舒张末期流速(EDV)和阻力指数(RI),比较不同性别间和左右两侧间骶外侧动脉第一背侧支的PSV、EDV和RI。由两位超声科医师对30名志愿者进行重复测量,分析测量值的可重复性。结果在解剖的尸体标本中,骶外侧动脉发出第一背侧支,经第一骶前孔由骶后孔穿出,随后发出分支进入骶骨外侧滋养孔。50名志愿者的100根骶外侧动脉第一背侧支均成功被探测到,其频谱呈高阻单向波形。骶外侧动脉第一背侧支的PSV为(29.3±4.1)cm/s,EDV为(5.3±1.1)cm/s,RI为0.82±0.04。男、女性志愿者间骶外侧动脉第一背侧支的PSV、EDV和RI的差异均无统计学意义(P值均>0.05),志愿者左、右两侧间骶外侧动脉第一背侧支的PSV、EDV和RI的差异均无统计学意义(P值均>0.05)。两位医师测得的:PSV、EDV和RI的组内相关系数分别为0.80、0.80和0.88,Bland-Altman图显示,除1名志愿者测得的PSV外,两位医师对骶外侧动脉第一背侧支血流动力学测量值的差值均位于95%的一致性界限内,表明两位医师的测量值的可重复性较好。结论骶外侧动脉第一背侧支是骶髂关节背侧的供血动脉,多普勒超声能有效探测该血管血流动力学表现。

Objective To confirm that the first foraminal ramus （FFR） of the lateral sacral artery is the supplying artery of the sacroiliac joint （SIJ） by autopsy and to summarize its normal hemodynamic performance by Doppler ultrasound. Methods We presented the normal anatomy of the FFR based on an anatomical dissection of a corpse, including origin, branches and blood-supply. Fifty asymptomatic volunteers underwent gray-scale image of the posterior wall of the pelvis and Doppler ultrasonography of the vessel. The peak systolic velocity （PSV）, end diastolic velocity （.EDV〉 and resistive index （RI） were measured. The inter-observer reliability was estimated according to the data from 30 patients by 2 physicians. Results In the cadaver, the FFR originated from the lateral sacral artery and sent out a branch to the lateral sacral nutrient foramen at the first posterior sacral foramen. All of the FFRs of the lateral sacral artery were successfully detected in the 50 volunteers. Spectrum Doppler was monophasic pattern with high resistance index. The mean PSV, EDV and RI of FFR were （29.3 ± 4. 1 ） cm/s, （5.3 ± 1.1 ） cm/s and 0.82 ± 0.04, respectively. There was no significant difference in PSV, EDV or RI between men and women （all P〉0.05）, or between the left and the right （all P〈0.05）. Intraclass correlation coefficient values for PSV, EDV and RI were 0.80, 0.80 and 0.88, respectively. The Bland-Altman chart showed that the measured values of two physicians had good repeatability. Conclusion The FFR of the lateral sacral artery is the nutrient artery of the lateral part of the sacrum, and ultrasound might be a useful imaging method to detect it. （Shanghai Med J, 2017, 40： 760-T64）