胸椎旁神经阻滞术穿刺深度的解剖学研究  

Anatomical study on puncture depth of thoracic paravertebral nerve block

作　　者：陈韦东 钱蕾 瞿东滨[1] 贺善礼 李泽宇 谭炜浩 钟锦涛 杨航 欧阳钧 郑明辉[1] CHEN Wei-dong;QIAN Lei;QU Dong-bin;He Shan-li;LI Ze-yu;TAN Wei-hao;ZHONG Jin-tao;Yang Hang;OU-YANG Jun;ZHENG Ming-hui(Department of Spinal Surgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China;Department of Anatomy,Guangdong Provincial Key Laboratory of Medical Biomechanics,Southern Medical University,Guangzhou 510515,China;The Second Clinical Medical College,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学南方医院脊柱骨科,广州510515 [2]南方医科大学基础医学院人体解剖学教研室,广东省医学生物力学重点实验室,广州510515 [3]南方医科大学第二临床医学院,广州510280

出　　处：《中国临床解剖学杂志》2020年第5期545-548,共4页Chinese Journal of Clinical Anatomy

基　　金：南方医院院长基金(2017B018)。

摘　　要：目的观察横突、肋横突外侧韧带与脊神经之间的毗邻关系,为提高超声引导下胸椎旁神经阻滞术的安全性及阻滞效能提供解剖学依据。方法选用18具标本胸椎节段,取椎板外侧缘和同名脊神经根的十字交点作为测量的起点,分别测量T112共12个节段脊神经与横突下后缘中点、肋横突外侧韧带下缘中点之间的距离。根据"3个一组"原则,12个节段共分为4组,记为T13组、T46组、T79组及T1012组,对不同组别的脊神经-横突间距、脊神经-肋横突外侧韧带间距分别进行单因素方差分析。结果(1)脊神经-横突间距:平均为(16.13±5.59)mm,T112总体呈先递增后递减的趋势,T5节段最大,为(18.88±5.78)mm,T5向上或向下节段逐渐减小,T1节段为(16.62±3.67)mm,T12节段为(9.76±3.75)mm。自上而下4组的脊神经-横突间距分别为(17.50±4.67)、(18.19±5.62)、(16.92±5.28)及(12.00±4.42)mm,T1012组相比T13组(P<0.01)、T46组(P<0.01)、T79组(P<0.01)有统计学差异。(2)脊神经-肋横突外侧韧带间距:平均为(17.67±3.76)mm,自上而下4组的间距分别为(16.95±3.82)、(17.55±3.89)、(17.81±3.83)及(18.30±3.43)mm,两两比较均无统计学差异(P>0.05)。结论了解脊神经-横突间距、脊神经-肋横突外侧韧带间距利于估算椎旁神经阻滞的安全穿刺深度,以提高阻滞效能,避免脊神经损伤及全脊髓麻醉的风险。Objective To improve the safety and effectiveness of ultrasound-guided paravertebral block through observing the relationship between the spinal nerve and the transverse process or the lateral costotransverse ligament in adult cadavers.Methods Eighteen cadavers with normal thoracic spines were collected in this study.The cross point between the lateral edge of the lamina and the thoracic spinal nerve root was taken as the starting point for measurement.The distances between the starting point and the midpoint of the posterior inferior border of transverse process and the midpoint of the inferior border of the lateral costotransverse ligament were measured.According to Mitchell FL’s "Three Groups" principle,the adjacent three thoracic segments were divided into 1 group and 12 segments were divided into 4 groups,which were named as T13 group,T46 group,T78 group and T1012 group,respectively.The one-way ANOVA were performed between the intervals of spinal nerve-transverse process and the intervals of spinal nervelateral costotransverse ligament in different groups.Results(1) Intervals of spinal nerve-transverse process:average distance was(16.13±5.59) mm.It showed a trend of increasing first and then decreasing from the segment T1(16.62±3.67) mm to the segment T12(9.76±3.75) mm.The T5 segment was the largest,which was(18.88≈5.78) mm.The upwards or downwards from T5 segment gradually decreased.The distance of spinal nerve-transverse process of T13 group,T46 group,T79 group and T1012 group were(17.50±4.67) mm、(18.19±5.62) mm、(16.92±5.28) mm、(12.00±4.42) mm respectively.There were significant differences among T1012 and T13(P<0.01),T46(P<0.01),T79 group(P<0.01).(2) Intervals of spinal nerve-lateral costotransverse ligament:average distance was(17.67 ± 3.76) mm.The distances of spinal nerve-lateral costotransverse ligament of T13,T46,T79 and T1012 group were(16.95± 3.82) mm、(17.55± 3.89) mm、(17.81 ± 3.83) mm、(18.30±3.43) mm,respectively.There was no significant difference between each two grou

关 键 词：胸椎旁神经阻滞术 超声引导 穿刺深度 应用解剖学 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]