目的 明确胸神经背外侧支（Dorsolateral branch, DLB）在竖脊肌深面与椎旁间隙之间的位置关系，为提高超声引导下行竖脊肌平面阻滞术提供解剖学依据。 方法 18具防腐固定的成人尸体标本，清除竖脊肌-横突平面与胸椎旁间隙之间的疏松组织，测量DLB与横突间韧带（Intertransverse ligament, ITL）、肋横突外侧韧带（Lateral costotransverse ligament, LCTL）之间的距离。 结果 竖脊肌与横突平面处的胸神经背外侧支通过一个骨纤维管与椎旁间隙中的脊神经相连通，其周围为疏松的结缔组织；竖脊肌-横突平面DLB与ITL、LCTL之间的距离从T1~T11总体呈现递增的关系，T1节段最小，分别为（4.86±1.81）mm和（5.02±1.60）mm，T11节段最大，分别为（7.94±2.43）mm和（8.43±2.57）mm。 结论 竖脊肌与横突平面处DLB可能是竖脊肌平面阻滞术的一个较理想的阻滞点，在超声引导下，使用ITL和LCTL作为定位标志行竖脊肌平面阻滞术具有可行性。
Abstract
Objective To investigate the positional relationship between the dorsolateral branch (DLB) of the thoracic nerve in the deep surface of the erector spinae muscle (ESM) and the paravertebral space by using cadaveric specimens, so as to provide anatomical evidence for improving ultrasound-guided erector spinae plane (ESP) block. Methods Eighteen embalmed and fixed adult cadaveric specimens were used. Loose tissue between the ESM-transverse process plane and the thoracic paravertebral space was removed to measure the distances between the DLB and the intertransverse ligament (ITL) and lateral costotransverse ligament (LCTL). Results The DLB of the thoracic nerve at the ESM-transverse process plane communicated with the spinal nerve in the paravertebral space through a bony-fibrous canal, surrounded by loose connective tissue. The distances between the DLB and ITL, and between the DLB and LCTL at the ESM-transverse process plane generally increased from T1 to T11. The smallest distances were observed at the T1 segment, which were (4.86±1.81) mm and (5.02±1.60) mm, respectively, while the largest distances were observed at the T11 segment, which were (7.94±2.43) mm and (8.43±2.57) mm, respectively. Conclusions The DLB at the ESM-transverse process plane may be an ideal block site for ESP block. Under ultrasound guidance, using the ITL and LCTL as localization landmarks is feasible for performing ESP block.
关键词
竖脊肌 /
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平面阻滞术 /
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阻滞点 /
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应用解剖学
Key words
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Erector spinae muscle /
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Plane block /
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Blocking point /
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Applied anatomy
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参考文献
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基金
广东省医学科学技术研究基金项目(202211169173678)
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