腰椎滑脱患者腰麻最佳穿刺角度的超声研究  

Ultrasonic study on the best puncture angle of spinal anesthesia in patients with spondylolisthesis

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作  者:刘京华 姚洪林 余得水[1] LIU Jing-hua;YAO Hong-lin;YU De-shui(Department of Anesthesiology,YibinHospital,West China Hospital,Sichuan University,Yibin,Sichuan 644000,China)

机构地区:[1]四川大学华西医院宜宾医院麻醉科,四川宜宾644000

出  处:《颈腰痛杂志》2022年第4期545-547,550,共4页The Journal of Cervicodynia and Lumbodynia

基  金:宁夏回族自治区自然科学基金(编号:NZ16212)。

摘  要:目的采用超声对比研究单节段腰椎滑脱患者和非腰椎滑脱患者腰麻(spinal anesthesia,SA)的最佳穿刺角度。方法选择33例接受SA下手术治疗的L_(5)-S_(1)单节段腰椎滑脱患者作为研究组,1:1配对选取同期接受SA下手术的非腰椎滑脱患者33例作为对照组。超声检查L_(5)-S_(1)水平和L_(4-5)水平横中线和旁正中矢状斜面最佳穿刺角度、黄韧带-硬脑膜复合体(ligamentum flavum dura complex,LFD)、皮肤至LFD的深度、皮肤至前复合体(anterior complex,AC)的深度及各节段和视图鞘内间隙宽度(LFD至AC距离)。结果观察组L_(5)-S_(1)水平横向中线视图最佳穿刺角度、旁正中矢状斜面最佳穿刺角度均显著高于对照组(P<0.05);两组患者L_(4-5)水平横向中线视图最佳穿刺角度、旁正中矢状斜面最佳穿刺角度差异均无统计学意义(P>0.05)。两组患者L_(5)-S_(1)和L_(4-5)水平的横向中线视图LFD深度、AC深度、LFD至AC距离及旁正中矢状斜面LFD层间高度、LFD深度、AC深度等差异均无统计学意义(P>0.05)。结论腰椎滑脱患者单滑脱水平SA穿刺针插入方向为尾侧成角,最佳穿刺角度高于无结构异常患者。Objective To study the optimal puncture angle of spinal anesthesia(SA)in patients with single level lumbar spondylolisthesis and non lumbar spondylolisthesis.Methods A total of 33 cases of L_(5)-S_(1)single segment lumbar spondylolisthesis treated by SA were selected as the study group,and 33 cases of non lumbar spondylolisthesis treated by SA in the same period were selected as the control group.The optimal puncture angle of transverse midline and paramedian sagittal slope at L_(5)-S_(1)and L_(4-5)levels,the interlayer height of ligamentum flavum dura complex(LFD),the depth from skin to LFD,the depth from skin to anterior complex(AC),and the width of intrathecal space(the distance between LFD and AC)at each segment and view were examined by ultrasonography.Results The L_(5)-S_(1)horizontal transverse midline view best punctureangle and paramedian sagittal oblique view best punctureangle in the observation group were significantly higher than those in the control group(P<0.05).There were no significant differences in L_(4-5)horizontal transverse midline view angle and paramedian sagittal oblique view angle between the two groups(P>0.05).There were no significant differences in LFD depth,AC depth,LFD to AC distance in L_(5)-S_(1)and L_(4-5)horizontal midline views and LFD interlayer height,LFD depth,AC depth in paramedian sagittal oblique views between the two groups(P>0.05).Conclusion The insertion direction of SA puncture needle at the level of spondylolisthesis in patients with lumbar spondylolisthesis is caudal angled,and the optimal puncture angle is higher than that in patients without structural abnormalities.

关 键 词:腰椎麻醉 超声引导 穿刺角度 腰椎滑脱 

分 类 号:R614[医药卫生—麻醉学]

 

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