下背痛超音波導引之注射治療

Ultrasound Guided Injection Techniques in the Treatment of Low Back Pain

陳柏旭(Carl P.C. Chen) ； 何長軒(Chan-Shien Ho) ； 陳靖倫(Jean-Lon Chen) ； 裴育晟(Yu-Cheng Pei)

《台灣醫學》 23卷3期 (2019/05) Pp. 330-334

https://doi.org/10.6320/FJM.201905_23(3).0005

摘要

下背痛是復健科門診常見的問題。在過去，實施下背痛的脊椎注射必須要仰賴X光機。但X光機會讓病患與注射者受到輻射之暴露，而且X光機無法看到神經、肌肉與血管等的軟組織。軟組織超音波是沒有輻射的，在執行導引注射時，所呈現的影像是立即的與清楚的。因此肌肉骨骼軟組織超音波可以用於正確的軟組織方面的疾病的診斷，亦能當做是準確的導引工具，正確的將針放至正確的位置來進行注射以達到最好的療效。透過肌肉骨骼軟組織超音波導引注射技術，可以成功的執行一些高難度並且需要精準性高的注射方法，例如特殊神經根阻斷法、骶裂孔注射、小面關節與內分支、骶髂關節與注梨狀肌注射等等。

關鍵字

下背痛 ； 肌肉骨骼軟組織超音波導引注射技術 ； 骶裂孔注射

並列摘要

In the past, expensive imaging tools such as the computed tomography (CT) and magnetic resonance imaging (MRI) were needed to diagnose musculoskeletal disorders. Presently, musculoskeletal ultrasound is frequently used to diagnose these problems with high accuracy and is radiation free. Musculoskeletal ultrasound can be applied as a needle guiding tool in performing interventional injection treatments for pain disorders. Needles can be accurately guided into the designated area for aspiration and injection procedures. Ultrasound can be applied in performing precise procedures such as caudal epidural, piriformis, lumbosacral facet and medial branch blocks, lumbar transforaminal, and sacroiliac joint injections for the treatment of low back pain. Under ultrasound guidance, the advancing motion of the needle can be observed as continuous and real-time images. In order to perform these injections successfully, the physician performing these procedures must be familiar with the sono-anatomy of the spine. In the lower back, anatomical structures of facet joints, transverse process, medial branches, piriformis muscles, sacroiliac joints, quadratus lumborum muscles, and sacral hiatus are crucial and need to be identified correctly under ultrasound in order to perform successful injection procedures for the treatment of low back pain.

並列關鍵字

low back pain ； ultrasound-guided intervention ； caudal epidural injection

參考文獻

Chen CP, Lew HL, Tsai WC, et al: Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil 2011;90:860-7.

Chen CP, Tang SF, Hsu TC, et al: Ultrasound guidance in caudal epidural needle placement. Anesthesiology 2004;101:181-4.

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Chen CP, Wong AM, Hsu CC, et al: Ultrasound as a screening tool for proceeding with caudal epidural injections. Arch Phys Med Rehabil 2010; 91: 358-63.

Park JH, Koo BN, Kim JY, et al: Determination of the optimal angle for needle insertion during caudal block in children using ultrasound imaging. Anaesthesia 2006;61:946-9.