骶髂关节穿刺术及其在强直性脊柱炎早期诊断中的应用研究进展

Progress on the sacroiliac joint puncture and its application in the early diagnosis of ankylosing spondylitis

目的 总结当前国内外骶髂关节（SIJ）穿刺术的要点及研究进展,以及SIJ穿刺术在强直性脊柱炎早期诊断中的应用.方法 以＂强直性脊柱炎＂＂骶髂关节穿刺＂为关键词,在PubMed、中国万方数据库检索1992年1月—2015年12月发表的关于SIJ穿刺术以及强直性脊柱炎早期诊断的文献,语种限定为中文和英文,总结骶髂关节穿刺术及其在强直性脊柱炎早期诊断中应用的研究进展.结果 SIJ穿刺的方法很多,操作手法也不尽相同.徒手穿刺术由于效率及安全性无法保证,已逐渐被淘汰.而超声对关节内组织辨识度差,MR引导下穿刺术费用较高,该两种穿刺术亦不常用.实际操作时透视下无法完全暴露SIJ间隙,逐渐被CT引导下穿刺术代替.CT引导下的SIJ穿刺被认为是最安全、可靠、高效的方式.SIJ穿刺针的种类多样,应根据骶髂关节病变的不同及SIJ穿刺引导方式的不同选择穿刺针.SIJ穿刺活检可更早发现骶髂关节炎的早期改变,是AS早期诊断的可靠方法.结论 SIJ穿刺活检可早期诊断AS.在SIJ穿刺时,操作者应从穿刺体位、穿刺引导方式、穿刺针的选择等多方面进行综合考虑,应根据骶髂关节病变的不同选择合适的引导方式和穿刺针.

Objective To summarize the current operating techniques and main points of the sacroiliac joint surgery at home and abroad, as well as function of sacroiliac joint puncture in the early diagnosis of ankylosing spondylitis. Methods To search the references related to application of sacroiliac joint puncture and sacroiliac joint injection in the diagnosis of ankylosing spondylitis from January 1992 to December 2015 in PubMed and WanFang datebase with the key words ＂ankylosing spondylitis＂, ＂Sacroiliac joint puncture＂. Language is limited to Chinese and English. To summarize in aspect of the puncture methods and function of sacroiliac joint puncture in the early diagnosis of ankylosing spondylitis. Results The operation methods of SIJ puncture are very different. Because its efficiency and safety cannot be guaranteed, hand puncture has been gradually eliminated. Because of the Ultrasound＇s poor identification within the joint tissue, and due to higher costs of MR-guided puncture, ultrasound and MR-guided puncture are not commonly used. The CT-guided SIJ puncture is considered to be the safest, most reliable and efficient way because the SIJ gap cannot be fully exposed by the c-arm during actual operation. Operators should choose different puncture needles based on the different ways and different sacroiliac joint lesions. SIJ puncture and biopsy can find earlier changes of sacroiliac arthritis, as well as is a reliable method of early diagnosis of AS. Conclusions SIJ biopsy is a reliable method of early diagnosis of AS, and the puncture position, ways of guidance, puncture methods and choice of needle should be taken into consideration. Different ways of guidance and needles can be used depending on the different sacroiliac joint lesions.