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
李娜 1李静 1张修文 2焦俊峰 2殷文渊 3巩文怡 4李晨光2
作者信息
- 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
- 折叠
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.
Abstract
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 fem-oral 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,ultrasound-guided 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 primar-ily 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 volun-teer 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 pericapsu-lar plexus block is a feasible nerve block technique with a block area covering the entire anterior knee without motor weakness.
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Key words
knee pericapsular plexus/nervus femoralis/saphenous nerve/ultrasound guidance/nerve block/sartorius muscle引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据