经骶管裂孔进行骶管囊肿穿刺的应用解剖学

目的 探索通过骶部骨性标志快速定位识别骶管裂孔，并阐明其与骶神经节和硬脊膜的位置关系，为从骶管裂孔进行骶管囊肿穿刺治疗的进针位置、角度和深度提供解剖学指导。 方法 取成人尸体标本15例。测量骶管裂孔到硬脊膜下界及骶神经节的距离，对骶角、骶管裂孔以及左右髂后上棘与骶角中点的位置关系进行了研究，对矢状切面进行了多种解剖学测量，记录穿刺针插入的角度和深度。结果 两侧骶角中点到尾骨末端的平均距离为(5.73±0.81)cm，两侧髂后上棘与骶角中点构成等腰三角形，3条边的尺寸在女性偏小，从骶管裂孔进针的平均俯角是60.4°，两侧骶角中点到达硬脊膜下界的距离大于到达第3骶神经节中点的距离，小于到达第1、2骶神经节中点的距离。 结论 总结出骶管裂孔的体表定位方法，阐明了骶管裂孔在体表的准确位置、深度及其与骶神经节和硬脊膜的位置关系，骶管裂孔进针的最佳角度，这些测量研究结果可帮助临床医师对骶管囊肿进行更安全的诊断和治疗，也可为骶管麻醉、骶前后区射频神经切断术，以及超声检查提供有用的参考。

Applied anatomy of intrusive operations of sacral cyst

Objective To identify sacral hiatus through the sacral bony landmarks, and to clarify its positional relationship with the sacral ganglion, and to provide anatomical guidance of the angle and depth of the needle for interventional operation through sacral hiatus. Methods Fifteen adult cadavers were included in this study. The distance and angle between the sacral hiatus and the sacral ganglion and the triangle which was formed by left and right posterior superior iliac spine and the midpoint of the sacral cornu were measured. Various anatomical measurements on the sagittal section were conducted. The angle and depth of the inserted puncture needle were recorded. Results Average distance from the midpoint of the sacral cornu to the end of the coccyx was (5.73 ± 0.81) cm. Both sides of the posterior superior iliac spine and the midpoint of sacral cornu constituted an isosceles triangle. The average depression angle of needle from the sacral hiatus was 60.4 degrees. Distance from the midpoint of both sides of the sacral hiatus to lower bound of the dural was greater than to the third sacral ganglion, and shorter than to the first and second midpoint of sacral ganglia. Conclusion This study summed up surface location of the sacral hiatus, clarified its body surface, depth, positional relationship with the sacral ganglion and the best angle for needle piercing. These findings can help clinicians perform safer diagnosis and treatment on the of the sides sacral cyst, and also provide a useful reference for caudal anesthesia, RF rhizotomy, and ultrasound examination.