文章摘要
腰椎CT对不同节段旁正中椎管内穿刺路径的测量及相关性分析
Lumbar CT measurement and correlation analysis of puncture paths in intravertebral anesthesia with paramedian approach in different segments
  
DOI：10.12089/jca.2019.05.013
中文关键词: 椎管内麻醉  旁正中穿刺法  CT测量  穿刺角度
英文关键词: Intravertebral anesthesia  Paramedian approach  CT measurement  Puncture angle
基金项目:
作者单位E-mail
张镇城 363000,漳州市,解放军联勤保障部队第909医院,厦门大学附属东南医院麻醉科  
张文龙 363000,漳州市,解放军联勤保障部队第909医院,厦门大学附属东南医院麻醉科  
卢承志 363000,漳州市,解放军联勤保障部队第909医院,厦门大学附属东南医院麻醉科 dincia@163.com 
何丽云 363000,漳州市,解放军联勤保障部队第909医院,厦门大学附属东南医院麻醉科  
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中文摘要:
      
目的 通过CT测量腰椎间隙指标，探讨其在旁正中穿刺法椎管内麻醉中的指导作用。
方法 选择本院2017年1~12月行腰椎CT的患者142例，男76例，女66例，年龄15~90岁，BMI 18.4~28.1 kg/m2，ASA Ⅰ—Ⅲ 级。选择L2-3、L3-4间隙上位下关节突内缘间距最大且下位椎板不可见层面作为测量层面，测量下关节突内缘到后正中矢状线最小距离，皮肤后正中点向一侧旁开10 mm作为模拟穿刺点，模拟穿刺针向内倾斜进针，测量穿刺针沿着同侧下关节突内缘通过椎板间隙的穿刺角度、穿刺针通过硬脊膜后正中点的穿刺角度、穿刺针沿着对侧下关节突内缘通过椎板间隙的穿刺角度。记录L2-3和L3-4间隙下关节突内缘到后正中线距离（IMD）、最小穿刺角度(MIN)、最佳穿刺角度(MID)、最大穿刺角度(MAX)、穿刺角度范围（MAX-MIN）。分析L2-3间隙IMD和MIN的相关性、IMD和MAX-MIN的相关性；L3-4间隙IMD和MIN的相关性、IMD和MAX-MIN的相关性。
结果 L2-3间隙IMD明显短于L3-4间隙（P<0.01），MIN 、MID和MAX明显大于L3-4间隙（P<0.05），MAX-MIN明显小于L3-4间隙（P<0.05）。L2-3间隙IMD与MIN呈明显负相关（r=-0.713，P<0.01），IMD与MAX-MIN呈明显正相关（r=0.802，P<0.01）；L3-4间隙IMD与MIN呈明显负相关（r=-0.772，P<0.01），IMD与MAX-MIN呈明显正相关（r=0.814，P<0.01）。
结论 通过腰椎CT发现，测量数据可以作为旁正中穿刺法参考指标，选择合适穿刺间隙和穿刺角度进行穿刺，避免一些普遍性错误，对穿刺经验不足麻醉科医师有指导价值。
英文摘要:
      
Ojective To explore the guiding role of CT in intravertebral anesthesia with paramedian approach by measuring lumbar intervertebral space index.
Methods A total of 142 patients with lumbar vertebral CT in our hospital from January to December 2017 were selected, 76 males and 66 females, aged 15 - 90 years, with a BMI 18.4 - 28.1 kg/m2, falling into ASA physical status I-III. The distance between the inner edge of the inferior articular process of L2-3 and L3-4 was the largest and the invisible layer of the lower lamina was used as the measurement level. The minimum distance from the inner edge of the inferior articular process to the posterior median sagittal line was measured. The posterior median point of the skin was opened 10 mm to one side as the simulated puncture point. The puncture needle was inclined inward. The puncture angle of the needle through the lamina vertebralis interstice along the inner edge of the ipsilateral inferior articular process, the needle through the posterior median point of the dura, and the needle through the lamina vertebralis interstice along the inner edge of the contralateral inferior articular process were measured. The inner edge of the inferior articular process to the median line distance (IMD), the minimum puncture angle (MIN), the optimal puncture angle (MID), the maximum puncture angle (MAX), the puncture angle range (MAX - MIN ) were recorded between L2-3 and L3-4. The correlation between IMD and MIN, IMD and MAX - MIN in L2-3 gap, IMD and MIN, IMD and MAX-MIN in L3-4 gap were analyzed.
Results The IMD of the L2-3 gap was significantly shorter than the L3-4 gap (P<0.01), the MIN, MID and MAX were significantly larger than the L3-4 gap (P<0.05), and the MAX-MIN was significantly smaller than the L3-4 gap (P<0.05). There was a significant negative correlation between IMD and MIN in L2-3 gap (r=-0.713, P<0.01). There was a significant positive correlation between IMD and MAX-MIN (r=0.802, P<0.01). IMD was negatively correlated with MIN in L3-4 gap. (r=-0.772, P<0.01), IMD was significantly positively correlated with MAX-MIN (r=0.814, P<0.01).
Conclusion Lumbar CT showed that the measured data could be used as a reference index for paramedian approach. Selecting appropriate puncture gap and puncture angle for puncture could avoid some common errors, which would be of guiding value to anesthesiologists with insufficient puncture experience.
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