腰方肌阻滞与肋缘下腹横肌平面阻滞在腹腔镜胃癌根治术后镇痛效果的比较

目的:比较超声引导下腰方肌阻滞（quadratus lumborum block, QLB）与肋缘下腹横肌平面阻滞（transverse abdominal plane block, TAPB）用于腹腔镜胃癌根治术的术后镇痛效果。方法:选择2021年1月至2021年7月择期在全身麻醉下行腹腔镜胃癌根治术的患者60例,采...     

腰方肌阻滞对腹腔镜肝切除术后急性疼痛影响的回顾性研究

目的　回顾性分析腰方肌阻滞对腹腔镜肝切除术后急性疼痛的影响。 方法　选取2018年1~8月于我院行择期腹腔镜肝切除术患者24例,平均分为2组,对照组仅采用全凭静脉麻醉,腰方肌组采用腰方肌阻滞（quadratus lumborum block,QLB）联合全凭静脉麻醉,两组术后镇痛方案均为自控静脉镇痛（patient controlled intravenous analgesia,PCIA）。麻醉期间常规监测患者心率、血压、脉搏氧饱和度,采用腰方肌阻滞的患者在阻滞完成后15 min记录阻滞平面。分别于术前、术后2 h、术后8 h、术后12 h、术后24 h和术后48 h对患者进行VAS评分。记录患者术中和术后PCIA阿片类药物消耗情况及术后48 h内恶心呕吐、尿潴留、瘙痒和呼吸抑制等并发症发生情况。 结果　腰方肌组患者在术后2、8、12 h 3个时间点VAS评分显著低于对照组,差异具有统计学意义（P<0.05）。腰方肌组12名患者最高阻滞平面为T6（T6~10）,最低阻滞平面为L1（T12~L1）。与对照组相比,腰方肌组术中和术后PCIA阿片类药物消耗均显著减少,差异具有统计学意义（P<0.05）。 结论　腰方肌阻滞能够有效缓解腹腔镜肝切除术患者术后急性期疼痛,减少围术期阿片类药物用量。     

A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section

BackgroundThis study aimed to compare the postoperative analgesic effects of ultrasound-guided posterior quadratus lumborum block with spinal morphine, after cesarean section, using the visual analogue scale pain score.MethodsOne-hundred-and-seventy-six pregnant women scheduled for elective cesarean section with spinal anesthesia were randomly allocated into four groups to receive spinal morphine 0.1 mg (group M⁺); spinal saline (M⁻); posterior quadratus lumborum block using either 0.3% ropivacaine (0.45 mL/kg each side, maximum 150 mg) group pQ⁺); or saline (pQ⁻). All patients received 11–13 mg hyperbaric bupivacaine 0.5% and 10 μg fentanyl. Intravenous droperidol, fentanyl and acetaminophen were administered during surgery. Bilateral posterior quadratus lumborum block was performed immediately after surgery. Postoperative pain was assessed at 0.5, 1, 2, 4, 6, 18 and 24 h after surgery, and the pain score 6 h after surgery was the primary endpoint.ResultsOne-hundred-and-forty-six patients were included in the final analysis. Pain scores 6 h after surgery, both at rest and when moving, were significantly different when comparing the M⁺pQ⁺ group with the M⁻pQ⁺ or M⁻pQ⁻ groups, and when comparing the M⁺pQ⁻ group with the M⁻ pQ⁺ or M⁻ pQ⁻ groups (all P <0.05). There was no significant difference between the M⁺pQ⁺ and M⁺pQ^– groups, or between the M⁻pQ⁺ and M⁻pQ⁻ groups.ConclusionSpinal morphine improved postoperative analgesia but the combination of posterior quadratus lumborum block with spinal morphine did not lead to further improvement.     

超声引导下腰方肌阻滞在腹膜透析置管术中的应用效果

目的观察超声引导下腰方肌阻滞在腹膜透析置管术中应用的有效性及安全性。方法选择择期行腹膜透析置管术终末期肾病患者90例,男49例,女41例,年龄45～65岁,ASAⅢ或Ⅳ级,随机分为三组,每组30例:A组采用局麻,B组采用0.5%罗哌卡因25 ml行超声引导下腹横肌平面阻滞,C组采用0.5%罗哌卡因25 ml行超声引导下腰方肌阻滞。记录麻醉前(T_0)、阻滞完成后30 min(T_1)、切皮时(T_2)、置管时(T_3)、打隧道穿刺出皮肤时(T_4)和缝合切口时(T_5)的MAP和HR;记录舒芬太尼追加例数,记录T_2—T_5时VAS评分和围术期不良反应的发生情况。结果 T_3—T_4时C组MAP明显低于A组和B组,HR明显慢于A组和B组(P0.05),B组MAP明显低于A组,HR明显慢于A组(P0.05)。T_3—T_4时C组VAS评分明显低于A组和B组(P0.05),B组VAS评分明显低于A组(P0.05)。C组舒芬太尼追加例数明显少于A组和B组(P0.05),A组舒芬太尼追加例数明显多于B组(P0.05)。三组下肢乏力发生率差异无统计学意义,三组均无一例其他不良反应。三组围术期均未发生明显的穿刺并发症。结论超声引导下腰方肌阻滞麻醉应用于终末期肾病患者腹膜透析置管术中效果确切,可减少麻醉性镇痛药的使用,不增加不良反应。     

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUNDLaparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years. We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia (PCIA) by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIMTo investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODSThis study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020. They were divided using a random number table into a research group (those who received quadratus lumborum block combined with PCIA analgesia by butorphanol) and a control group (those who received only PCIA analgesia by butorphanol), with 60 patients in each group. Demographic factors, visual analog scale scores for pain, serum inflammatory markers, PCIA compressions, Ramsay scores, and adverse events were compared between groups using a t-test, analysis of variance, or χ² test, as appropriate.RESULTSThere were no significant differences in demographic factors between groups (all P > 0.05). The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group (P < 0.05). Two hours after surgery, there were no significant differences in the levels of serum tumor necrosis factor-α, interleukin (IL)-6, or IL-8 between groups (P > 0.05). The serum tumor necrosis factor-α levels of the research group 24 h postoperatively were significantly lower than those of the control group (P < 0.05). The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group (P < 0.05).CONCLUSIONLumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation, instances of PCIA compression, and adverse reactions.     

腰方肌阻滞用于老年患者肾癌根治术的镇痛效果评价

目的:评价腰方肌阻滞(quadratus lumborum block,QLB)用于老年患者后腹腔镜肾癌根治术的镇痛效果。方法:选择2017年6月至2018 年6月在我院择期行后腹腔镜肾癌根治术患者60例,年龄65~76 岁,ASA I-Ⅲ级,采用随机数字表法分为全麻联合腰方肌阻滞组(Q 组)和单纯全麻组(C组),每组30例。Q组患者于全麻诱导后行超声引导下术侧腰方肌阻滞,C组行单纯全麻。两组术后均使用静脉自控镇痛,视觉模拟评分（VAS）大于6分时5 mg地佐辛静注行补救镇痛。记录两组患者切皮前（T0）、切皮后5 min （T1）的收缩压（SBP）、舒张压（DBP）和心率（HR）,计算切皮前后差值,记录术后6、12和24 h VAS评分,记录术中瑞芬太尼用量、术后镇痛泵首次按压时间、舒芬太尼用量、补救性镇痛次数、术后首次下床时间和术后满意度。记录术后24 h内恶心呕吐、皮肤瘙痒、苏醒期躁动和呼吸抑制等不良反应发生情况,Q组记录腰方肌阻滞相关并发症的发生情况。结果:Q组切皮前、切皮后5 min,SBP、DBP 和HR的差值均明显小于C组(P＜0.05);Q组术后6、12 h VAS评分显著低于C组(P＜0.05),术中瑞芬太尼用量显著少于C组(P＜0.05);镇痛泵首次按压时间显著晚于C组(P＜0.05);术后0~6 h、6~12 h 舒芬太尼用量明显少于C 组(P＜0.05);补救性镇痛发生率明显低于C 组(P＜0.05);术后首次下床活动时间明显早于C组(P＜0.05),术后镇痛满意度明显高于C组(P＜0.05)。术后恶心呕吐、苏醒期躁动的发生率显著低于C组(P＜0.05),皮肤瘙痒和呼吸抑制的发生率无显著差异(P＞0.05),Q组未见腰方肌阻滞相关并发症。结论:腰方肌阻滞可显著降低老年患者后腹腔镜肾癌根治术阿片类药物的用量,增强术后镇痛效果,提高患者满意度。     

超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的影响

目的 研究超声引导下腰方肌阻滞中罗哌卡因复合地塞米松对全髋关节置换术后镇痛的疗效。
方法 选择2019年12月至2020年12月行全髋关节置换术的患者90例,男40例,女50例,年龄65～78岁,ASA Ⅰ或Ⅱ级。采用随机分组的方法分成罗哌卡因复合地塞米松组（D组）,罗哌卡因组（Y组）和单纯静脉自控镇痛（PCIA）组（R组）,每组30例。D组术后以罗哌卡因100 mg复合地塞米松0.1 mg/kg为药液行腰方肌阻滞同时联合PCIA作为术后镇痛,Y组术后以单纯罗哌卡因100 mg为药液行腰方肌阻滞并联合PCIA为术后镇痛,R组则采用单纯PCIA作为对照。记录三组术后4、6、12、24和48 h静息和活动时VAS疼痛评分以及术后48 h内镇痛泵按压次数及曲马多补救例数。同时记录术后48 h内恶心呕吐、呼吸抑制和术后谵妄等不良反应发生情况,记录患者对术后镇痛的满意度。
结果 术后4、6、12、24和48 h D组和Y组静息和活动时VAS疼痛评分明显低于R组（P<0.05）,术后12、24 h D组的静息和活动时VAS疼痛评分明显低于Y组（P<0.05）。术后48 h D组和Y组内镇痛泵按压次数和曲马多补救例数明显少于R组（P<0.05）,且D组明显少于Y组（P<0.05）。术后48 h内D组和Y组恶心呕吐发生率明显低于R组（P<0.05）,且D组明显低于Y组（P<0.05）。三组均未发生呼吸抑制和术后谵妄。D组术后镇痛的满意度评分明显高于Y组和R组（P<0.05）。
结论 超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的效果好,不良反应少,提高患者对术后镇痛的满意度。     

Segmentation of the quadratus lumborum muscle using statistical shape modeling

Purpose:

To compare automated segmentation of the quadratus lumborum (QL) based on statistical shape modeling (SSM) with conventional manual processing of magnetic resonance (MR) images for segmentation of this paraspinal muscle.

Materials and Methods:

The automated SSM scheme for QL segmentation was developed using an MR database of 7 mm axial images of the lumbar region from 20 subjects (cricket fast bowlers and athletic controls). Specifically, a hierarchical 3D‐SSM scheme for segmentation of the QL, and surrounding psoas major (PS) and erector spinae+multifidus (ES+MT) musculature, was implemented after image preprocessing (bias field correction, partial volume interpolation) followed by image registration procedures to develop average and probabilistic MR atlases for initializing and constraining the SSM segmentation of the QL. The automated and manual QL segmentations were compared using spatial overlap and average surface distance metrics.

Results:

The spatial overlap between the automated SSM and manual segmentations had a median Dice similarity metric of 0.87 (mean = 0.86, SD = 0.08) and mean average surface distance of 1.26 mm (SD = 0.61) and 1.32 mm (SD = 0.60) for the right and left QL muscles, respectively.

Conclusion:

The current SSM scheme represents a promising approach for future automated morphometric analyses of the QL and other paraspinal muscles from MR images. J. Magn. Reson. Imaging 2011;33:1422–1429. © 2011 Wiley‐Liss, Inc.     

经后外侧入路仅切断股方肌的股骨头置换术疗效分析

目的　探讨仅切断股方肌的改良后外侧入路与传统后外侧入路行股骨头置换术的近期临床疗效。 方法　选取行单侧人工股骨头置换术的患者60例,其中20例采用仅切断股方肌的改良后外侧入路手术（改良组）,40例实施常规后外侧入路手术（传统组）。比较两组患者的手术时间、出血量、手术前后血红蛋白差值、VAS评分及Harris评分、术后并发症及首次下地时间。 结果　60例患者均顺利完成手术。与传统组相比,改良组术中出血量较少、术后首次下地时间较早、手术时间较长、手术前后血红蛋白差值较小、术后2周髋关节Harris评分较高、术后24 h VAS评分较低,差异有统计学意义（P<0.05）。两组切口均Ⅰ期愈合,传统组1例患者出现术后假体后脱位,予手法复位外展支具固定1月后未再发生脱位。术后半年随访,两组Harris评分无统计学差异（P>0.05）。末次随访时两组均未发生假体松动、感染等并发症。 结论　仅切断股方肌的改良后外侧入路具有围手术期出血少,术后疼痛轻、恢复快等优势,但其远期疗效有待进一步观察。     

The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture

The anatomy of the middle layer of lumbar fascia (MLF) is of biomechanical interest and potential clinical relevance, yet it has been inconsistently described. Avulsion fractures of the lumbar transverse processes (LxTP’s) are traditionally attributed to traction from psoas major or quadratus lumborum (QL), rather than transversus abdominis (TrA) acting via the MLF. This attachment is also absent from many biomechanical models of segmental control. The aims of this study were to document: (1) the morphology and attachments of the MLF and (2) the attachments of psoas and QL to the LxTP’s. Eighteen embalmed cadavers were dissected, measuring the thickness, fibre angle and width of the MLF and documenting the attachments of MLF, psoas and QL. The MLF was thicker at the level of the LxTP’s than between them (mean 0.62: 0.40 mm). Psoas attached to the anteromedial surface of each process and QL and TrA to its lateral border; QL at its upper and lower corners and TrA (via the MLF) to its tip. In three cadavers, tension applied to the MLF fractured a transverse process. The MLF has a substantial and thickened attachment to the tips of the LxTP’s which supports the involvement of TrA in lumbar segmental control and/ or avulsion fracture of the LxTP’s.