经骶后孔骶管阻滞的临床应用解剖  

Clinical anatomy of sacral block through posterior sacral foramen

作　　者：陈忠孝[1] 余汝堂[1] 杨新东[1] 郑建武[1] 

机构地区：[1]温州医学院基础医学实验中心,浙江温州325035

出　　处：《中国临床解剖学杂志》2008年第5期503-506,共4页Chinese Journal of Clinical Anatomy

基　　金：温州医学院科研发展基金(XNK07008)

摘　　要：目的:探索适合骶后孔骶管阻滞的精确定位方法及其进针角度和深度,为临床骶管阻滞和注射提供解剖学依据。方法:选取28例尸体标本,层次解剖并测量骶后各结构,对半劈开或打开骶管后壁,观测骶管各结构。以通过两侧髂嵴最高点连线为X1轴,以通过两骶角连线为X2轴,以骶后正中嵴垂线为Y轴进行定位。结果:①第2、3骶后孔的精确定位X1轴坐标分别为:男(68.45±5.78)、(86.91±6.14)mm,女(60.44±6.30)、(78.60±7.23)mm,X2轴坐标分别为:男(52.46±5.24)、(31.00±4.62)mm,女(48.26±4.32)、(30.20±4.27)mm,Y轴坐标分别为:男(20.76±2.53)、(19.20±2.50)mm,女(19.58±2.10)、(17.45±2.32)mm。②硬膜囊下端一般平对第2骶椎,与第2骶后孔上缘水平的距离为(13.07±5.50)mm。结论:第2、3骶后孔均可作为经骶后孔进针骶管阻滞麻醉的理想部位,推荐采用倒"工"形双重坐标法定位,穿刺角度宜向内、下偏斜矢状轴30°～40°,进针深度分别为9.3mm、6.4mm为宜。Objective： To explore the precise localization and suitable needing angle and depth for sacral block through posterior sacral foramen, and provide anatomic data for clinical applications of sacral anesthesia. Methods 28 cadavers were dissected layer by layer and measured the structures of the posterior aspect of the sacrum. And then the sacrum was cleaved at the midline to open the posterior wall of the sacral canal for observing and measuring the structures of the sacral canal. For the precise allocation, the line between the highest points of the bilateral iliac crests was drawn as axis X1, and the line between bilateral sacral horns as axis X2. The perpendicular line on the posterior median sacral crest was labeled as Y axis. Results： （1） The precise positions of the second and third posterior sacral foramina were （68.45±5.78） mm and （86.91±6.14）mm in male, （60.44±6.30） mm and （78.60±7.23）mm in female on axis X1, （52.46±5.24） mm and （31.00±4.62） mm in male, and （48.26±4.32） mm and （30.20±4.27）mm in female on axis X2, and （20.76±2.53）mm and （19.20± 2.50） mrn in male, and （19.58±2.10）mm and （17.45±2.23） mm in female on axis Y, respectively. （2）The inferior extremity of the dural sac was generally at the level of the second sacral vertebra. The horizontal distance from the dural sac to the superior margin of the second posterior sacral foramina was about （13.07±5.50） mm. Conclusions： The second and third posterior sacral foramen can be used as an ideal position to insert needle into the sacral canal through the posterior sacral foremen for sacral block anesthesia. It is recommended that the double coordinates localization in a reverse ＂ T. ＂ shape can be adopted, and that the inserting angle should be directed to the ＂medial side and 30-400 downwards obliquely to the sagittal axis, with the depth of the inserting of 9.3 mm and 6.4 mm respectively.

关 键 词：骶后孔 骶管阻滞 药物注射 麻醉 

分 类 号：R323.46[医药卫生—人体解剖和组织胚胎学] R614.42[医药卫生—基础医学]