腰椎PVP/PKP椎弓根外侧浸润麻醉的局部解剖学研究  

Anatomic study of extrapedicular infiltration anesthesia for lumbar PVP/PKP

作　　者：张沂虎 董博赞 王建刚 梁勇 周强 刘列华 ZHANG Yi-hu;DONG Bo-zan;WANG Jian-gang;LIANG Yong;ZHOU Qiang;LIU Lie-hua(Department of Anesthesiology,General Hospital of Chonggang,Chongqing 400081,China;Department of Spine Surgery,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Orthopedics,13th People′s Hospital of Chongqing,Chongqing 400053,China;Department of Radiology,First Affiliated Hospital of the Army Medical University,Chongqing 400038,China)

机构地区：[1]重钢总医院麻醉科,重庆400081 [2]重庆医科大学附属第三医院脊柱外科,重庆401120 [3]重庆市第十三人民医院骨科,重庆400053 [4]陆军军医大学第一附属医院放射科,重庆400038

出　　处：《局解手术学杂志》2020年第6期469-473,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫生和计划生育委员会医学科研面上项目(2016MSXM084)。

摘　　要：目的观测与椎弓根外侧浸润麻醉有关的应用解剖学参数,为腰椎椎弓根外侧浸润麻醉的应用提供解剖学依据。方法收集2016年12月至2017年8月重庆市第十三人民医院66例中老年患者的脊椎CT三维重建影像资料,使用CT后处理工作站观测L1、L2、L3、L4、L5的相关解剖学参数,包括矢状面角、皮肤进针点到椎弓根体表投影上缘及外缘的距离(分别为距离AD、距离BC)、水平面角、麻醉针在横突前方的穿刺深度、腰椎前凸角度。结果L1矢状面角男女患者间比较差异无统计学意义(P=0.061),其余各参数男女患者间比较差异有统计学意义(P<0.05)。L1、L2、L3、L4、L5的矢状面角、距离AD、水平面角、距离BC、麻醉针在横突前方的穿刺深度比较,各椎间差异有统计学意义(P=0.000)。腰椎前凸角为50°及以上患者的L4、L5矢状面角及AD距离较腰椎前凸角度为50°以下的患者大,差异有统计学意义(P=0.000)。L1的皮肤进针点为椎弓根体表投影上4mm、外8mm,矢状面角8°、水平面角7°;L2的皮肤进针点为椎弓根体表投影上6mm、外10mm,矢状面角10°、水平面角9°;L3的皮肤进针点为椎弓根体表投影上9mm、外13mm,矢状面角12°、水平面角12°;L4的皮肤进针点为椎弓根体表投影上12mm、外18mm,矢状面角15°、水平面角18°;L5的皮肤进针点为椎弓根体表投影上21mm、外25mm,矢状面角23°、水平面角24°。结论掌握好麻醉针的皮肤进针点和穿刺方向,从解剖学的角度可以实现精准的腰椎椎弓根外侧浸润麻醉。Objective To observe the applied anatomical parameters related to extrapedicular infiltration anesthesia and to provide anatomic basis for the application of lumbar extrapedicular infiltration anesthesia.Methods CT three-dimensional reconstruction images of 66 middle-aged and elderly patients who were admitted into the 13th People′s Hospital of Chongqing from December 2016 to August 2017 were collected.The CT post-processing workstation was used to observe the relevant anatomical parameters in L1,L2,L3,L4 and L5,including the sagittal section angle,the distance from the skin penetration point to the upper and outer edge of the pedicle projection on the skin(distance AD and distance BC,respectively),the transverse section angle,the depth of the anesthesia needle in front of the transverse process,and the angle of lumbar lordosis.Results There was no significant difference between male and female sagittal section angle in L1(P=0.061),and there were significant differences between male and female in other parameters(P<0.05).The sagittal section angle,distance AD,transversesection angle,distance BC,and depth of the anesthesia needle in front of the transverse process in L1,L2,L3,L4,and L5 were compared respectively,and intervertebral differences were statistically significant(P=0.000).The sagittal section angle and distance AD of L4 and L5 in patients with lumbar lordosis angle≥50°were larger than those with lumbar lordosis<50°,and the differences were significant(P=0.000).In L 1,the skin penetration point was 4 mm above the upper edge of the pedicle projection on the skin and 8 mm outside the outer edge of the pedicle projection on the skin;the sagittal section angle was 8°and the transverse section angle was 7°.In L2,L3,L4,and L5,the four parameters were 6 mm,10 mm,10°,9°;9 mm,13 mm,12°,12°;12 mm,18 mm,15°,18°;21 mm,25 mm,23°,24°,respectively.Conclusion Confirmed the skin penetration point and puncture direction of the anesthesia needle,the lumbar extrapedicular infiltration anesthesia could be accu

关 键 词：椎弓根外侧浸润麻醉 椎体成形术 体表投影 皮肤进针点 穿刺方向 解剖 

分 类 号：R614[医药卫生—麻醉学]