胸椎旁神经阻滞术穿刺深度的解剖学研究

doi:10.13418/j.issn.1001-165x.2020.05.010

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (5): 545-548.doi: 10.13418/j.issn.1001-165x.2020.05.010

胸椎旁神经阻滞术穿刺深度的解剖学研究

陈韦东¹，　钱蕾²，　瞿东滨¹，　贺善礼²，　李泽宇²，　谭炜浩³，
钟锦涛³，　杨航¹，　欧阳钧²，　郑明辉¹

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

收稿日期:2019-11-14 出版日期:2020-09-25 发布日期:2020-10-21
通讯作者: 郑明辉，副主任医师，E-mail：turtle668@126.com
作者简介:陈韦东（1994-），男，广东湛江人，硕士研究生，研究方向：基础解剖及脊柱外科，E-mail：2448838220@qq.com
基金资助:
南方医院院长基金（2017B018）

Anatomical study on puncture depth of thoracic paravertebral nerve block

CHEN Wei-dong¹, QIAN Lei², QU Dong-bin¹, He Shan-li ², LI Ze-yu², TAN Wei-hao³, ZHONG Jin-tao³, Yang Hang¹, OU-YANG Jun²，ZHENG Ming-hui¹

1. Department of Spinal Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China；2.Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou 510515, China； 3. The Second Clinical Medical College, Southern Medical University, Guangzhou 510280, China

Received:2019-11-14 Online:2020-09-25 Published:2020-10-21

摘要/Abstract

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T1~12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T1~3组、T4~6组、T7~9组及T10~12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，T1~12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，T10~12组相比T1~3组（P<0.01）、T4~6组（P<0.01）、T7~9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。

关键词: 胸椎旁神经阻滞术, 　超声引导, 　穿刺深度, 　应用解剖学

Abstract: 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 T1~3 group, T4~6 group, T7~9 group and T10~12 group, respectively. The one-way ANOVA were performed between the intervals of spinal nerve-transverse process and the intervals of spinal nerve- lateral 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 T1~3 group, T4~6 group, T7~9 group and T10~12 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 T10~12 and T1~3 (P<0.01), T4~6 (P<0.01), T7~9 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 T1~3 , T4~6 , T7~9 and T10~12 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 groups (P>0.05). Conclusions　It is important to pre-estimate the puncture depth before and during ultrasound-guided thoracic paravertebral nerve block to avoid spinal nerve injury and even spinal anesthesia.

Key words: Thoracic paravertebral block；　Ultrasound-guided；　Puncture depth；　Applied anatomy

中图分类号:

R322

陈韦东, 钱蕾, 瞿东滨, 贺善礼, 李泽宇, 谭炜浩, 钟锦涛, 杨航, 欧阳钧, 郑明辉. 胸椎旁神经阻滞术穿刺深度的解剖学研究[J]. 中国临床解剖学杂志, 2020, 38(5): 545-548.

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. Anatomical study on puncture depth of thoracic paravertebral nerve block[J]. Chinese Journal of Clinical Anatomy, 2020, 38(5): 545-548.

参考文献 18

[1]	Womack J, Pearson JD, Walker IA, et al. Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study[J]. Anaesthesia, 2019, 74(5): 594-601.
[2]	Miyawaki H, Ogata H, Nakamoto S, et al. Effects of thoracic paravertebral block on nociceptive levels after skin incision during video-assisted thoracoscopic surgery[J]. Med Sci Monit, 2019, 25: 3140-3145.
[3]	Sondekoppam RV, Uppal V, Brookes J, et al. Bilateral thoracic paravertebral blocks compared to thoracic epidural analgesia after midline laparotomy: a pragmatic noninferiority clinical trial[J]. Anesth Analg, 2019, 129(3): 855-863.
[4]	Marhofer P, Harrop-Griffiths W, Kettner SC, et al. Fifteen years of ultrasound guidance in regional anaesthesia: part 1[J]. Br J Anaesth, 2010, 104(5): 538-546.
[5]	Wang YF, Xu XQ, Yuan HJ. Inadvertent spinal anesthesia during ultrasound-guided thoracic paravertebral nerve block in a patient with nerve root sheath cyst[J]. A A Pract, 2019: 12(6): 199-201.
[6]	Krediet AC, Moayeri N, van Geffen GJ, et al. Different approaches to ultrasound-guided thoracic paravertebral block: an Illustrated review[J]. Anesthesiology, 2015, 123(2): 459-474.
[7]	Geelhoed MA, Viti JA, Brewer PA. A pilot study to investigate the validity of the rule of threes of the thoracic spine[J]. J Manual Manipulative Therapy, 2005, 13(2): 91-93.
[8]	Moore DC. "No paresthesias-no anesthesia," the nerve stimulator or neither[J]? Reg Anesth, 1997, 22(4): 388-390.
[9]	Hu Z, Liu D, Wang ZZ, et al. The efficacy of thoracic paravertebral block for thoracoscopic surgery: a meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2018, 97(51): e13771.
[10]	Reusz G, Sarkany P, Gal J, et al. Needle-related ultrasound artifacts and their importance in anaesthetic practice[J]. Br J Anaesth, 2014, 112(5): 794-802.
[11]	Eason MJ, Wyatt R. Paravertebral thoracic block? a reappraisal[J]. Anaesthesia, 1979, 34(7): 638-642.
[12]	Richardson J, Cheema SP, Hawkins J, et al. Thoracic paravertebral space location. A new method using pressure measurement[J]. Anaesthesia, 1996, 51(2): 137-139.
[13]	Paraskeuopoulos T, Saranteas T, Kouladouros K, et al. Thoracic paravertebral spread using two different ultrasound-guided intercostal injection techniques in human cadavers[J]. Clin Anat, 2010, 23(7): 840-847.
[14]	Neal JM, Barrington MJ, Brull R, et al. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine: executive summary 2015[J]. Reg Anesth Pain Med, 2015, 40(5): 401-430.
[15]	Lang SA. The use of a nerve stimulator for thoracic paravertebral block[J]. Anesthesiology, 2002, 97(2): 521-522.
[16]	Cowie B, Mcglade D, Ivanusic J, et al. Ultrasound-guided thoracic paravertebral blockade: a cadaveric study[J]. Anesth Analg, 2010, 110(6): 1735-1739.
[17]	Chelly JE, Uskova A, Merman R, et al. A multifactorial approach to the factors influencing determination of paravertebral depth[J]. Can J Anaesth, 2008, 55(9): 587-594.
[18]	Boretsky K, Visoiu M, Bigeleisen P. Ultrasound-guided approach to the paravertebral space for catheter insertion in infants and children[J]. Paediatr Anaesth, 2013, 23(12): 1193-1198.

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

可视化

摘要/Abstract

引用本文

使用本文

参考文献 18

相关文章 4

Metrics

本文评价

推荐阅读 0

[1]	陈仁, 杨胜波. 咬肌的解剖与临床应用研究进展[J]. 中国临床解剖学杂志, 2024, 42(1): 115-117.
[2]	孙诗竹, 　于胜波, 　隋鸿锦. P45断层塑化技术在应用解剖学研究中的应用[J]. 中国临床解剖学杂志, 2021, 39(2): 240-243.
[3]	陈韦东, 谭炜浩, 钟锦涛, 杨斌, 陈志敏, 马纯玲, 瞿东滨, 郑明辉. 胸椎旁神经阻滞技术的研究进展[J]. 中国临床解剖学杂志, 2021, 39(1): 111-114.
[4]	赵宏明,杨宪,杨胜波. 根据肌内神经分布定位髂腰肌和腰方肌痉挛的阻滞靶点[J]. 中国临床解剖学杂志, 2019, 37(1): 5-8.