超声引导下经弓状韧带上或前路腰方肌阻滞在腹腔镜全子宫切除术中的比较

目的 探讨超声引导下经弓状韧带上入路或前路腰方肌阻滞（QLB）在腹腔镜全子宫切除术中的镇痛效果。
方法 择期行腹腔镜全子宫切除术的患者38例,年龄18～64岁,BMI 16～29 kg/m²,ASA Ⅰ或Ⅱ级。随机分为经前路QLB组（C组）和经弓状韧带上QLB组（E组）,每组19例。麻醉诱导前在超声引导下C组行双侧前路QLB,E组行弓状韧带上QLB,每侧给予0.3%罗哌卡因20 ml。记录术后住院时间、阻滞操作时间、阻滞后起效时间,测定阻滞后5、10、20、30 min的阻滞平面和术中瑞芬太尼和麻黄碱用量。记录术后2、6、12、24、48 h的VAS疼痛评分和补救镇痛,局麻药中毒、血肿、严重低血压、内脏损伤、肌力下降等神经阻滞并发症和恶心呕吐等不良反应。
结果 两组术后住院时间、阻滞操作时间差异无统计学意义。E组阻滞起效时间明显短于C组（P<0.05）。阻滞后5、10、20、30 min E组阻滞平面节段数量明显多于C组（P<0.05）。术后2、6、12 h E组静息和活动时VAS疼痛评分明显低于C组（P＜0.05）。两组均无补救镇痛,术中瑞芬太尼、麻黄碱用量,局麻药中毒、血肿、严重低血压、内脏损伤、肌力下降等神经阻滞并发症和恶心呕吐等不良反应差异无统计学意义。
结论 在腹腔镜全子宫切除术中经弓状韧带上腰方肌阻滞较传统前路腰方肌阻滞起效更快,阻滞平面更广,术后12 h镇痛效果更好。     

L1 radiculopathy mimicking meralgia paresthetica: A case report

L1 radiculopathy is very rare and difficult to diagnose with needle electromyography. A patient presented with pain and hypesthesia on the anterolateral aspect of the left thigh. Nerve conduction studies and needle electromyography were normal, except for the quadratus lumborum and iliopsoas muscles, which showed abnormal spontaneous activity and polyphasic motor unit potentials with reduced recruitment patterns. Magnetic resonance imaging of the lumbar spine showed disc extrusion of the L1–2 intervertebral space with upward migration. This case demonstrates the usefulness of examination of the quadratus lumborum in the diagnosis of L1 radiculopathy. Muscle Nerve 41: 566–568, 2010     

股方肌骨瓣植骨术治疗股骨颈骨折远期疗效观察

报告３０例股方肌骨瓣植骨术治疗股骨颈骨折的远期疗效，全部病例作了系统追访，最长１０年，最短３年，平均６年零５个月；２９例骨性愈合，占９６．６％，股骨颈变短变粗愈合１１例占３６．６％，股骨头坏死６例，占２０％，股骨头坏死出现时间平均３年零２个月，本组病例说明股方肌骨瓣植骨术能提高股骨颈骨折愈合率，未能降低股骨头坏死率。股骨头坏死与髋关节功能不成正比关系，而股骨颈变短变粗愈合则直接影响髋关节的功能。     

超声引导下腰方肌阻滞在体外冲击波碎石术中的应用

目的:探讨超声引导下腰方肌阻滞在体外冲击波碎石术中的应用。方法:选取2019年3月至2020年3月在本院收治的输尿管结石患者108例,按照随机数字表法分为对照组(53例)和观察组(55例)。两组患者均行体外冲击波碎石术治疗,观察组患者在超声引导下行腰方肌阻滞干预,对照组患者给予连续硬膜外麻醉干预。比较两组患者的排石率、...     

空心加压螺钉联合股方肌骨瓣移植治疗39例青壮年股骨颈骨折

目的探讨空心加压螺钉内固定结合股方肌骨瓣移植治疗青壮年股骨颈骨折的临床疗效。方法 2005年1月～2010年12月,对有移位的39例青壮年股骨颈骨折患者,予以采用髋关节后外侧切口,切开复位,空心加压螺钉内固定加股方肌骨瓣移植治疗。结果所有患者均获随访,时间1～3年。骨折均一期骨性愈合,骨性愈合时间3～6个月(平均4.8个月)。效果评定参照Harris评分标准,优31例(79.49%),良6例(15.39%),差2例(5.12%),优良率达94.88%。结论空心加压螺钉内固定结合股方肌骨瓣移植治疗青壮年股骨颈骨折具有损伤小、固定牢靠、骨折愈合快以及并发症少等优点,是值得临床使用的一种方法。     

股方肌骨瓣移植治疗股骨颈骨折的基础及临床研究

从1974年1月～1991年12月,共用股方肌骨瓣移植加内固定治疗股骨颈骨折97例.同时在尸体标本上对股方肌的形态和骨瓣的血液供应进行观察.发现股方肌骨瓣为一有肌蒂和血管蒂双重血供的骨瓣,血供丰富,肌蒂长度足够.临床随访55例,24例获3年至18年零7个月的长期随访.术后骨折愈合率98.2%,股骨头缺血坏死率14.55%.按董天华法髋功能评分标准:本组83.7±20.4分.认为该手术操作简单,容易掌握,术时短,创伤小,具有能显露股骨颈后上方骨质缺损并易植骨的独特优点;术后骨愈合率高,股骨头坏死率低,髋功能恢复好,是带蒂植骨治疗股骨颈骨折较好的手术方法.     

Morphologie und Innervation der Mm. levatores costarum und ihre Beziehung zu den Mm. intertransversarii laterales lumborum. Untersuchungen an Mensch und K?nguruh

Zusammenfassung Untersucht wurden Mm. levatores costarum an 21 menschlichen Torsen, wobei die Intercostalräume teils von dorsal teils von ventral angegangen wurden. Mm. levatores costarum longi kommen regelmäßig im oberen und unteren Thorakalbereich vor, im mittleren Thorakalbereich mit erheblicher Variabilität. Homologe Muskeln zwischen 11., 12. Brustwirbel und 1., 2. Lendenwirbel weisen auf eine Verwandtschaft zu den Mm. intertransversarii laterales lumborum hin. Mm. levatores costarum können sowohl von ventral als auch von dorsal innerviert werden, nachweislich an 3 menschlichen Präparaten im unteren Thorakalbereich. Sie können deswegen als den Mm. intertransversarii posteriores cervicis homolog angesehen werden. Mm. intertransversarii laterales lumborum werden ebenso wie die Mm. levatores costarum hauptsächlich von Dorsalästen der Spinalnerven versorgt, zeigen aber auch ventrale Zuschüsse und sind somit den Levatores costarum einerseits und den Intertransversarii posteriores cervicis andererseits homolog. Bezüglich der Morphologie bestätigen diese Befunde Eisler und Cave, während sie bezüglich der Innervation von ihnen abweichen. Bei einem Känguruh (Macropus spec.) wurden ausschließlich Mm. levatores costarum breves gefunden, die nur aus dem dorsalen Spinalnervenast innerviert wurden. Diese Beobachtung bestätigt die vergleichenden Untersuchungen von Steubl.

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Morphology and innervation of the Mm. levatores costarum and their relation to the Mm. intertransversarii

Summary The levatores costarum were studied in 21 human cadavers by dissection from the anterior and posterior aspect. The levatores costarum longi regularly were found in the upper und lower thoracic region, but with extreme variability in the middle thoracic region. Corresponding muscles between 11th, 12th thoracic vertebra and 1st, 2nd lumbar vertebra indicate the close relation to the Mm. intertransversarii laterales lumborum. The levatores can be innervated by the dorsal ramus of the spinal nerve as well as by the ventral ramus, shown in the upper thoracic region of 3 human cadavers. Therefore it is surmised, that the levatores costarum correspond to the intertransversarii post. cervicis. The intertransversarii laterales lumborum in the same way as the levatores costarum are mainly supplied by the dorsal ramus, but also receive twigs of the ventral ramus. Thus on one hand they correspond to the levatores, on the other hand to the intertransversarii post. cervicis. As to homologies these findings agree with Eisler and Cave, as to innervation, they disagree with them. In one kangaroo (macropus spec.) exclusively levatores costarum breves were found, which are supplied only by the dorsal ramus of the spinal nerve. This observation confirms the comparative investigations of Steubl.

Den Gesamtentwurf und die Untersuchung beim Menschen besorgte W. Langenberg, die Untersuchungen beim Känguruh steuerte S. Jüschke unter Anleitung von Prof. Dr. Engländer bei.     

腰方肌与腹横肌平面阻滞在妇科腹腔镜术后的镇痛效果比较

【摘要】目的 比较腰方肌阻滞（QLB）和腹横肌平面阻滞（TAPB）用于妇科腹腔镜手术患者术后镇痛的效果。方法选取于2016年1月～2017年6月在重庆市人口和计划生育科学技术研究院接受妇科腹腔镜手术的患者127例,ASAⅠ或Ⅱ级,随机分为QLB组(n=64)和TAPB组(n=63)。术后在超声引导下分别行双侧QLB或TAPB,在双侧腰方肌后表面或腹内斜肌和腹横肌之间给予0375%的罗哌卡因40 mL,两组均行术后镇痛。观察并记录两组患者首次按压镇痛泵的时间,术后首次下床活动时间,术后4、8、12、24和48 h患者的疼痛VAS评分, BCS舒适度评分,术后48 h内舒芬太尼的消耗量;记录术后恶心呕吐、眩晕、皮肤瘙痒等不良反应的发生情况。结果 两组患者均未观察到QLB 和TAPB相关并发症。QLB组患者术后首次按压镇痛泵的时间明显长于TAPB组（P＜005）,首次下床活动时间明显早于TAPB组（P＜005）;与TAPB组比较,QLB组术后8、12、24 h的VAS评分降低,BCS评分升高（P＜005）;术后0~12 h、12~24 h、24~36 h QLB组舒芬太尼消耗量明显小于TAPB组（P＜005）。QLB组术后过度镇静、恶心呕吐、眩晕的发生率明显低于TAPB组。结论 QLB较TAPB能够更有效地为妇科腔镜手术患者提供理想的术后多模式镇痛效果,并且可以减少术后阿片类药物用量及不良反应的发生,有利于促进患者康复。     

超声引导下肋下前路腰方肌阻滞对后腹腔镜肾脏手术后镇痛效果的影响

目的观察和比较超声引导下肋下前路腰方肌阻滞(QLB)与低位胸椎旁神经阻滞(TPVB)用于后腹腔镜肾脏手术后镇痛的效果。方法择期行后腹腔镜肾脏手术患者70例,男38例,女32例,年龄18～65岁,BMI 18～24 kg/m~2,ASAⅠ或Ⅱ级。随机分为肋下前路QLB组(QLB组)和低位TPVB组(TPVB组),每组35例。QLB组行超声引导下患侧肋下前路QLB,TPVB组行超声引导下患侧T_(10)横突水平TPVB,两组分别注入0.33%罗哌卡因30 ml,注药后20 min测定感觉阻滞平面。两组术后行羟考酮PCIA。记录术后0～24 h和24～48 h镇痛泵用量、有效按压次数、总按压次数;记录术后2、6、12、24、36、48 h静息时和运动时的NRS评分;记录术后48 h内补救镇痛和低血压、肌力减退、恶心呕吐、嗜睡等不良反应发生情况。结果 QLB组阻滞平面为T_5—L_2,TPVB组为T_5—T_(12)。QLB组术后0～24 h和24～48 h镇痛泵用量明显低于TPVB组(P0.05),有效按压次数和总按压次数明显少于TPVB组(P0.05),术后12、24、36、48 h运动时NRS评分明显低于TPVB组(P0.05),术后48 h内补救镇痛、恶心呕吐和嗜睡发生率明显低于TPVB组(P0.05)。两组低血压和肌力减退发生率差异无统计学意义。结论与低位TPVB比较,超声引导下肋下前路QLB联合羟考酮PCIA在后腹腔镜肾脏手术后镇痛的效果更显著,持续作用时间更长,不良反应更少。     

Cross‐sectional area of lumbar spinal muscles and vertebral endplates: a secondary analysis of 91 computed tomography images of children aged 2–20

Spinal muscle cross‐sectional area has been highly associated with spinal pathology. Despite the medium‐high prevalence of spinal pathology in children, there is very limited knowledge regarding muscle size and growth pattern in individuals younger than 20 years of age. The aim of this study is to analyze the change in size and symmetry of spinal muscles (erector spinae, multifidus, psoas and quadratus lumborum) in children 2–20 years of age. We studied reformatted images from 91 abdominal computed tomographic scans of children aged 2–20 years, from an existing imaging dataset. The cross‐sectional area of the muscles was bilaterally measured parallel to the upper endplate of the lumbar vertebrae L3–L5 and at true horizontal for S1. The cross‐sectional area of the upper vertebral endplate was measured at spinal levels L3–L5. Results were analyzed according to six groups based on children's age: 2–4 years (group 1), 5–7 years (group 2), 8–10 years (group 3), 11–13 years (group 4), 14–16 years (group 5) and 17–20 years (group 6). Vertebral endplate and spinal muscles cross‐sectional area increased with age. Two patterns were observed: Endplate, psoas and quadratus lumborum increased up to our 6th oldest age group (17–20), and multifidus and erector spinae reached their largest size in the 5th age group (14–16). The epaxial muscles (erector spinae and multifidus) reached their maximal cross‐sectional area before skeletal maturity (18–21 years of age). The hypaxial muscles (psoas and quadratus lumborum) continued to increase in size at least until spinal maturity. Contributing factors for the differences in developmental pattern between the epaxial and hypaxial muscles might include functional, embryological and innervation factors. In conclusion, this research is the first to describe the cross‐sectional area of spinal muscles in children. Future longitudinal studies are needed for further understanding of muscle development during childhood and adolescence. Level of evidence: level 2b, Retrospective cohort study.