实时超声引导技术在脊髓性肌萎缩症合并严重脊柱侧凸病人腰椎穿刺中的应用  

Real-time Ultrasound Guidance in Lumbar Puncture for Patients with Spinal Muscular Atrophy and Severe Scoliosis

作　　者：柯希建 吴银竹 张旻 李觅 KE Xijian;WU Yinzhu;ZHANG Min;LI Mi(Department of Anesthesiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Respiratory and Critical Care,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Orthopedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Shenzhen Huazhong University of Science and Technology Research Institute,Shenzhen 518000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030 [2]华中科技大学同济医学院附属同济医院呼吸内科,武汉430030 [3]华中科技大学同济医学院附属同济医院神经内科,武汉430030 [4]华中科技大学同济医学院附属同济医院骨科,武汉430030 [5]深圳华中科技大学研究院,深圳518000

出　　处：《骨科》2023年第6期547-552,共6页ORTHOPAEDICS

基　　金：同济医院留学人员回国启动基金(2022HGRY019);广东省基础与应用基础研究基金(2020A1515110021)。

摘　　要：目的探讨实时超声引导技术在脊髓性肌萎缩症(spinal muscular atrophy,SMA)合并严重脊柱侧凸病人腰椎穿刺中应用的临床疗效。方法回顾性分析2022年1月至2023年8月经华中科技大学同济医学院附属同济医院收治的8例确诊为SMA合并严重脊柱侧凸病人的临床资料,男2例,女6例,SMA2型5例,SMA3型3例,年龄为20~51岁。病例均收治于我院神经内科,送至手术室由麻醉科医生采用实时超声引导技术进行腰椎穿刺和鞘内注射诺西那生钠治疗。记录穿刺成功率、穿刺节段、入路、操作时长、疼痛视觉模拟量表(VAS)评分、病人满意度评分、即时和随访不良反应发生情况。结果8例病人共进行45次穿刺,成功率为100%。3例病人采用L3/4节段右侧入路,5例病人选择L2/3节段左侧入路。4例病人选择经椎间孔入路,另4例病人选择经椎板入路。操作时长:(24.1±8.7)min,VAS评分:(2.2±0.7)分,病人满意度评分:(8.3±0.8)分。病人平均随访时间为6个月,未出现神经损伤、穿刺部位感染、血肿等严重不良反应。结论对于SMA合并严重脊柱侧凸病人,采用实时超声引导腰椎穿刺技术成功率高,病人满意度高,且无严重不良反应,值得在临床中进一步推广和应用。Objective To study the clinical efficacy of real⁃time ultrasound guidance technique in lumbar puncture for patients with spinal muscular atrophy(SMA)and severe scoliosis.Methods A retrospective analysis was conducted on the clinical data of 8 patients diagnosed as SMA with severe scoliosis,admitted to Tongji hospital from January 2022 to August 2023.There were 2 males and 6 females,with 5 cases of SMA type 2 and 3 cases of SMA type 3,aged between 20 and 51 years old.All patients were admitted to the department of neurology and received lumbar puncture and intrathecal injection of Nusinersen sodium using real⁃time ultrasound guidance technique in the operating room.The success rate of the puncture,puncture position,approach,procedure duration,visual analogue scale(VAS)score for pain,patient satisfaction score,and occurrence of immediate and follow⁃up adverse events were recorded.Results A total of 45 lumbar punctures were performed on 8 patients with severe scoliosis.The success rate was 100%.Among the patients,the right⁃sided L3/4 approach was used in 3 cases,and the left⁃sided L2/3 approach in 5 cases.The transforaminal approach was done in 4 patients,and the posterior interlaminar approach was done in the remaining 4 patients.The procedure duration was(24.1±8.7)min,the VAS score was 2.2±0.7,and the patient satisfaction score was 8.3±0.8.During the follow⁃up period of 6 months,no severe adverse events such as nerve damage,infection at the puncture site,or hematoma occurred.Conclusion Real⁃time ultrasound guidance technique for lumbar puncture in patients with spinal muscular atrophy and severe scoliosis has a high success rate,high patient satisfaction,and no severe adverse events.It is worth further promotion and application in clinical practice.

关 键 词：实时超声引导技术 脊髓性肌萎缩症 严重脊柱侧凸 腰椎穿刺 经椎间孔入路 

分 类 号：R744.8[医药卫生—神经病学与精神病学] R682.3[医药卫生—临床医学]