超声引导膝周神经丛阻滞的解剖学和临床研究  

Ultrasound-guided knee pericapsular plexus block:A cadaver and a volunteer study

作　　者：李娜 李静[1] 张修文 焦俊峰 殷文渊 巩文怡 李晨光[2] Li Na;Li Jing;Zhang Xiuwen;Jiao Junfeng;Yin Wenyuan;Gong Wenyi;Li Chenguang(Department of Anesthesiology,Shanghai Jiao Tong University affiliated Sixth people's Hospital,Shanghai 201306,China;Department of Anesthesiology,The First People's Hospital of Tianshui,Tianshui 741000,Gansu,China;Department of Anesthesiology,Dachang Hospital of Baoshan District,Shanghai 200444,China;Department of Anesthesiology,Wusong Central Hospital of Baoshan District,Shanghai 200940,China)

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海201306 [2]天水市第一人民医院麻醉科,甘肃天水741000 [3]上海宝山区大场医院麻醉科,上海200444 [4]上海宝山区吴淞中心医院麻醉科,上海200940

出　　处：《兰州大学学报（医学版）》2024年第8期25-30,47,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：上海市老龄化和妇儿健康研究专项资助项目(2020YJZX0127)。

摘　　要：目的探讨超声引导膝周神经丛阻滞技术的可行性及其麻醉区域。方法超声下在10具尸体的双下肢定位和追踪组成膝周神经丛的4条神经,包括股外侧皮神经前支、股中间皮神经、隐神经髌下支和股内侧皮神经前支,并在成像最清晰的位置注射0.01%亚甲蓝,解剖尸体,明确神经的染色情况;将25名志愿者的单侧下肢进行超声引导膝周神经丛阻滞,记录麻醉区域和下肢运动情况。结果尸体研究显示:4条神经在超声下均可清晰鉴别。股中间皮神经、隐神经髌下支和股内侧皮神经前支分别经过在缝匠肌的不同水平穿过或折返至该肌表面,随后走行于该肌和股内侧肌表面。股外侧皮神经前支在大腿前部主要走行于股直肌表面。亚甲蓝注射后,所有的膝周神经丛均被染色,股神经和隐神经未被染色。志愿者研究显示:髌周神经丛阻滞后的麻醉区域下至胫骨粗隆、上至大腿上端,内侧至股骨内上髁内侧缘,外侧至股骨外上髁外侧缘,范围可覆盖整个膝前区。平均阻滞持续时间为14.72 h。所有志愿者均未出现下肢运动障碍。结论超声引导膝周神经丛阻滞是一种可行的神经阻滞技术,其麻醉区域可覆盖整个膝前区,且不影响下肢运动。Objective To investigate into the feasibility of ultrasound-guided knee pericapsular plexus block and to test its block area.Methods The study was designed in two parts involving cadavers and volunteers.First,the four nerves constituing the knee pericapsular plexus,including the anterior branch of the lateral femoral cutaneous nerve,intermediate femoral cutaneous nerve,inferior patellar branch of the saphenous nerve,and anterior branch of the medial femoral cutaneous nerve,were identified and followed on the lower limbs of ten cadavers under ultrasound guidance.Then a solution of 0.01%methylene blue was injected into the most optimal imaging location,followed by cadaver dissection to evaluate nerve staining.Second,ultrasoundguided knee pericapsular plexus block was performed on one lower limbs of every 25 volunteers,followed by a recording of the block area and lower limb mobilization of the affected leg.Results The cadaver study revealed that all four nerves could be clearly identified under ultrasound.The intermediate femoral cutaneous nerve,inferior patellar branch of the saphenous nerve,and anterior branch of the medial femoral cutaneous nerve pierced or wound around the sartorius muscle and then ran superficial to it followed by being superficial to the junction of the sartorius muscle and vastus medialis muscle.The lateral femoral cutaneous nerve primarily ran superficial to the rectus femoris muscle in the anterior thigh.After dye injection,the knee pericapsular plexus of all cadavers were stained,while the femoral and saphenous nerves remained unstained.The volunteer study showed that the block area after knee pericapsular plexus block extended from the tibial tuberosity to the upper end of the thigh,medially to the inner edge of the medial condyle and laterally to the outer edge of the lateral condyle,covering the entire anterior knee area.The average blocking duration was 14.72 h,and no volunteers experienced motor weakness in the lower limbs.Conclusion Ultrasound-guided knee pericapsular plexus block i

关 键 词：膝周神经丛 股神经 隐神经 超声引导 神经阻滞 缝匠肌 

分 类 号：R614.4[医药卫生—麻醉学]