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1、·692·中华医学杂志2002年5月25日第82卷第10期NatlMedJChina,May25,2002,Vol82,No.10·论著·CT导引骶髂关节穿刺活检和注射技术的应用刘源王庆文肖壮伟陈肃标曾庆馀【摘要】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,28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4/6,28例患者穿刺到位率96.4%(54/56)。穿刺层面距骶
2、髂关节下缘1.69cm±0.63cm。活检标本获取率88.5%(46/54),病理检查阳性率91.7%(22/24)。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%(22/28)。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。【关键词】放射学,介入性;骶髂关节;活组织检查,针吸;注射,关节内＊CT-guidedpercutaneousneedlebiopsyand
3、intra-articularinjectionofsacroiliacjointLIUYuan,WANG＊Qingwen,XIAOZhuangwei,CHENSubiao,ZENGQingyu.DepartmentofRadiology,FirstHospital,ShantouUniversityMedicalSchool,Shantou515041,China【Abstract】ObjectiveToinvestigatetheclinicalvalueofCT-guidedpercutaneousneedlebiopsyandintra-articularinj
4、ectionofsacroiliacjoint.MethodsCT-guidedpercutaeouspuncturewasconductedtothebilateralsacroiliacjointsof3specimensofadultpelvis,18patientswithankylosingspondylitis(AS),and10patientswithundifferentiatedspondyloarthropathy(uSpA)suspectedasearlyASclinically.All28patientshadtakennon-steroidal
5、anti-inflammatoryagentswithoutadequatecontrolofsymptomsorwithserioussideeffects.Biopsyofsynoviumwith16Gor18Gneedlesandintra-articularinjectionofsteroidweremadetothe28patients.ResultsThegeneralsuccessrateofpuncturewas4/6amongthespecimensofpelvisandwas96.4%(54/56)amongthe28patients.Theleve
6、lofneedleinsertionwas1.69cm±0.63cmuptheloweredgeofthejoint.Theobtainmentrateofbiopsyspecimenwas88.5%(46/54)forthecasespuncturedsuccessfully.Thepositiverateofpathologicalexaminationwas91.7%(22/24).MarkedinflammatorychangeswerefoundinthebiopsyspecimensfromASpatientsandearlyinflammatorychan
7、geswerefoundinthebiopsyspecimensfromuSpApatients.Theimmediateeffectiverateofintra-articularsteroidinjectionwas78.6%(22/28).Nocomplicationandsideeffectwasfound.ConclusionCT-guidedpercutaneouspunctureisaneffectiveandsafeguidedmethodforbiopsyandintra-articularinjectionofsacr
