胸膜顶形态与周围常用穴位关系的临床解剖研究

目的:探讨正常成人胸膜顶形态与其周围常用穴位针刺安全的关系。方法:采用小号克氏针标定法和层次解剖法,解剖46具正常成人尸体胸部标本,观测胸膜顶的形态及其变异、胸膜顶周围常用穴位的安全深度及其与胸膜顶形态的关系等项目。结果:在锁骨上缘观测到胸膜顶投影宽度等于锁骨内1/3段者占全部标本的32.6%,投影宽度大于锁骨内1/3段者占全部标本的59.8%,投影宽度小于锁骨内1/3段且胸膜顶内侧界位于胸锁关节内侧者占全部标本的7.6%;观察到诸如天突、气舍、肩井、定喘及大杼等通常被认为与胸膜顶似乎无关的穴位,按标准的穴位定位和方向行针,超过一定限度时即能穿过胸膜造成破坏。结论:胸膜顶的位置及其形态特点与上部胸膜腔周围穴位针刺意外的发生存在解剖学结构上的联系,应引起临床针灸医生的警惕和重视。

Clinically anatomic study on the relation between the form of pleural cupula and its surrounding commonly-used acupoints

Objective To explore the relation of the form of pleural cupula of the normal adult with safety of acupuncture at commonly-used acupoints around the pleural cupula. Methods The safe depth for the commonly-used acupoints around the pleural cupula and the relation with the form of pleural cupula were investigated in 46 adult corpses with small Kirschner wire location and arrangement dissection. Results The width of the pleural cupula projection equal to clavicle medial 1/3 accounted for 32.6% of all the corpses, and the width of the pleural cupula projection more than clavicle medial 1/3 accounted for 59.8% of all the corpses, the width of the pleural cupula projection less than clavicle medial 1/3 and pleural cupula medial margin located at the sternoclavicular joint medial accounted for 7.6% of all the corpses. The observed points such as Tiantu (CV 22), Qishe (ST 11), Jianjing (GB 21), Dingchuan (EX-B1), Dazhu (BL 11) which were considered be not related to the pleural cupula. When acupuncture is carried out according to criteria of acupoint location and needling direction, and the needle exceeded a limit, the pleural menbrane will be broken and induce destruction. Conclusion Position and form of the pleural cupula have anatomical relation to acupuncture accident for needling the points around the superior pleural cupula, which should be played attention to.