CT导引骶髂关节穿刺活检和注射技术在强直性脊柱炎早期诊断与治疗中的作用

背景影像学方法是强直性脊柱炎(ankylosing spondylitis,AS)主要的检查手段,CT导引技术可为AS的早期诊断和临床治疗提供补救手段.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在AS的早期诊断与治疗中的作用.设计非随机对照的研究.地点、对象和干预本实验在在汕头大学医学院第一附属医院放射科完成.实验选取盆部标本3具(标本组)、汕头大学医学院风湿病研究室患者18例(AS组)和拟诊早期AS的未分化脊柱关节病(undifferentiatedspondyloarthropathies,uSpA)患者10例(uSpA组).在CT导引下,经臀部皮肤作骶髂关节穿刺,28例患者并作滑膜部活检和注射治疗.主要观察指标穿刺的部位和成功率、标本阳性率、治疗有效率.结果盆部标本穿刺到位率67%(4/6),28例患者穿刺到位率96%(54/56).穿刺层面距骶髂关节下缘(1.69±0.63)cm.活检标本获取率88%(46/54),病理检查阳性率92%(22/24).AS组和uSpA组患者的骶髂关节见炎症改变.关节内注射治疗近期有效率79%(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、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.

Effect of CT-guided biopsy and intra-articular injection technique in sacroiliac joint on early diagnosis and treatment of ankylosing spondylitis

BACKGROUND: Imaging is a main examination method of ankylosing spondylitis(AS), and CT-Guided technique provides remedy for the early diagnosis and treatment of AS.OBJECTIVE: To evaluate the effect of CT-Guided percutaneous biopsy of sacroiliac joint and intra-articular injection on the early diagnosis and treatment of ankylosing spondylitis.DESIGN: A nonrandomly controlled study.SETTING, PARTICIPANTS and INTERVENTIONS: The experiment was carried out in the Department of Radiation, First Affiliated Hospital, Medical College of Shantou University. 3 adult pelvic part specimens(specimen group),18 ankylosing spondylitis patients(AS group) from the Department of Rheumatosis, Medical College of Shantou University and 10 undifferentiated spondyloarthropathies(uSpA) cases suspected to have early AS clinically(uSpA group). All the patients received sacroiliac puncture through skin of buttock,and biopsy of synovial as well as injection therapy under CT guidance.MAIN OUTCOME MEASURES: The puncture spot and rate of success,the positive rate of the sample and the efficacy of therapy.RESULTS: The successive rate of puncture in pelvic sample was 67% (4/6),and that of 28 patients was 96% (54/56). The distance between the site of puncture and the lower edge of sacroiliac joint was(1.69 ±0. 63) cm. The obtainment of biopsy sample was 88% (46/54), and the pathologic positive rate was 92% (22/24). The marked inflammatory changes in sacroiliac joint was demonstrated in patients in AS and uSpA group. The efficiency of intra-articular injection treatment was 79% (22/28) . No side reaction and complication were found in all cases.CONCLUSION: CT is an effect and safe means of sacroiliac joint puncture;and the proper pathway of puncture is at the middle-lower 1/3 of the sacroiliac joint. Biopsy can improve the threshold of early diagnosis of sacroiliitis of uSpA patients. Intra-articular injection is an effective supplementary therapy to AS and uSpA general drug treatment.