超音波導引尾骨硬脊膜外注射（caudal injection）於僵直性脊椎炎患者──病例報告

Patients with ankylosing spondylitis can perform ultrasound guided caudal epidural injection for pain control: 3 cases report

僵直性脊椎炎患者若遇開刀需做麻醉會遇到困難呼吸道及半身麻醉不易的問題，但下背痛也是僵直性脊椎炎患者常見的問題。過去有案例是以尾骨硬脊膜外注射成功完成髖關節手術，但很少討論影像導引應用於僵直性脊椎炎患者的疼痛治療上。我們用超音波導引的方式成功注射了尾骨硬脊膜外注射於三例僵直性脊椎炎患者並得到不錯的疼痛緩解效果。在超音波的導引下可以清楚的看見患者薦骨裂孔與薦尾韌帶的鈣化程度，並幫助完成疼痛注射治療。此後或許可用影像導引尾骨硬脊膜外注射的方式為類似患者做一個安全且有效的慢性疼痛處置。

Anesthesiologists may face difficulty maintaining the airway for general anesthesia or regional anesthesia in patients with ankylosing spondylitis (AS) to maintain their airway for general anesthesia or perform regional anesthesia due to ossification of the axial bone during surgery. However, low back pain is also a common problem in AS patients. Administration of caudal epidural injections to AS patients undergoing hip surgery has been reported. Nevertheless, few reports have addressed imaging techniques for chronic pain treatment in AS patients. We administered ultrasound-guided caudal epidural injections to three AS patients (all men, 48-64 years of age, with confirmed diagnosis from 5-20 years) to successfully reduce chronic pain (more than 50% pain relief). Under ultrasound guidance, we identified the ossification of the sacral hiatus and sacrococcygeal ligament and administered the injection without difficulty. Ultrasound-guided caudal block is a safe and effective approach for chronic low back pain in AS patients.