后支阻滞麻下腰椎手术5885例报告  

Dorsal Ramus Blocking Anesthesia for 5885 cases of Lumbar Vertebra Surgery

作　　者：陈仲[1] 靳安民[1] 邵振海[1] 张志方[2] 

机构地区：[1]第一军医大学珠江医院脊柱骨科,广东广州510282 [2]第一军医大学珠江医院麻醉科

出　　处：《实用骨科杂志》2001年第6期479-481,共3页Journal of Practical Orthopaedics

摘　　要：目的：介绍一种改进了的腰椎后路手术的局麻方法──脊神经后支阻滞法。方法：０．５％普鲁卡因１００ｍＬ和２％利多卡因２０ｍＬ混合备用。先在切口处皮内注射５ｍＬ麻药，再于手术侧病变节段旁阻滞５根脊神经后支主干（上３下２），麻药用量３～５ｍＬ。脊神经后支主干位于横突根部上缘。其体表投影点的确定方法是通过上下棘突连线的上中１／３交界点作一水平线，该线是板突的上缘线的体表投影，旁开腰１棘突２ｃｍ取一点，再旁开腰５棘突３ｃｍ取一点；通过这两点作一直线，该线与各横线的交点即为各脊神经后支主干部的发出点。结果：５８８５ 例麻醉效果：优４１９７（７１．３％），良１４２４（２４．２％），中２３５（４％），差２９（０．５％）．效果差者，经静脉使用镇痛镇静类药也取得较好效果。结论：腰椎间盘手术采用脊神经后支阻滞麻醉经济安全可靠．Objectives: To introduce a kind of improved local anesthesia-Spinal dorsal rami blocking,for lumbar vertebra surgery via posterior access Methods: 0. 5% procaine 100mL and 2% lidocaine 20mL are mixed ready for use.Five milliliters anaesthetic is injected hypodermic along the skin incision line. Five dorsal rami (three over,2,be- low)were blocked with 3～5mL of anaesthetic besides the ill segment at the same side. The stem part of dorsal ramus located at the upper edge of the basis of transverse processus. Its projective point on the skin can be located as follow- ing. make transverse lines between two processus which cut superior one third of the length. Make a 1ongitudinal line 2cm lateral from L1 processus and 3cm slateral from L5 processus. The cross points of the two lines are the projecting points of the stem part of dorsa1 rami. Results:A total of 5885 cases underwent this method were reviewed. The effect were divided into 4 categories: excellent 4197 (71. 3% ),good 1424 (24. 2% ),medium 235 (4 ), bad 29 (0. 5% ). As for the those with bad effect,antalgic and ataractic were used intravenous,and get satisfying results. Conclusion The dor- sal rami blocking anesthesia for lumbar disc surgery is economy safe and reliable.

关 键 词：脊神经后支阻滞法 腰椎后路手术 局部麻醉 

分 类 号：R614.4[医药卫生—麻醉学]