胸椎旁神经阻滞术穿刺深度的解剖学研究

目的　观察横突、肋横突外侧韧带与脊神经之间的毗邻关系，为提高超声引导下胸椎旁神经阻滞术的安全性及阻滞效能提供解剖学依据。 方法　选用18具标本胸椎节段，取椎板外侧缘和同名脊神经根的十字交点作为测量的起点，分别测量T1~12共12个节段脊神经与横突下后缘中点、肋横突外侧韧带下缘中点之间的距离。根据“3个一组”原则，12个节段共分为4组，记为T1~3组、T4~6组、T7~9组及T10~12组，对不同组别的脊神经-横突间距、脊神经-肋横突外侧韧带间距分别进行单因素方差分析。 结果　（1）脊神经-横突间距：平均为（16.13±5.59）mm，T1~12总体呈先递增后递减的趋势，T5节段最大，为（18.88±5.78）mm，T5向上或向下节段逐渐减小，T1节段为（16.62±3.67）mm，T12节段为（9.76±3.75）mm。自上而下4组的脊神经-横突间距分别为（17.50±4.67）、（18.19±5.62）、（16.92±5.28）及（12.00±4.42）mm，T10~12组相比T1~3组（P<0.01）、T4~6组（P<0.01）、T7~9组（P<0.01）有统计学差异。（2）脊神经-肋横突外侧韧带间距：平均为（17.67±3.76）mm，自上而下4组的间距分别为（16.95±3.82）、（17.55±3.89）、（17.81±3.83）及（18.30±3.43）mm，两两比较均无统计学差异（P>0.05）。 结论　了解脊神经-横突间距、脊神经-肋横突外侧韧带间距利于估算椎旁神经阻滞的安全穿刺深度，以提高阻滞效能，避免脊神经损伤及全脊髓麻醉的风险。

Anatomical study on puncture depth of thoracic paravertebral nerve block

Objective　To improve the safety and effectiveness of ultrasound-guided paravertebral block through observing the relationship between the spinal nerve and the transverse process or the lateral costotransverse ligament in adult cadavers. Methods Eighteen cadavers with normal thoracic spines were collected in this study. The cross point between the lateral edge of the lamina and the thoracic spinal nerve root was taken as the starting point for measurement. The distances between the starting point and the midpoint of the posterior inferior border of transverse process and the midpoint of the inferior border of the lateral costotransverse ligament were measured. According to Mitchell FL's "Three Groups" principle, the adjacent three thoracic segments were divided into 1 group and 12 segments were divided into 4 groups, which were named as T1~3 group, T4~6 group, T7~9 group and T10~12 group, respectively. The one-way ANOVA were performed between the intervals of spinal nerve-transverse process and the intervals of spinal nerve- lateral costotransverse ligament in different groups. Results （1）Intervals of spinal nerve-transverse process：average distance was (16.13±5.59) mm. It showed a trend of increasing first and then decreasing from the segment T1 (16.62±3.67) mm to the segment T12（9.76±3.75) mm. The T5 segment was the largest, which was(18.88±5.78) mm. The upwards or downwards from T5 segment gradually decreased. The distance of spinal nerve-transverse process of T1~3 group, T4~6 group, T7~9 group and T10~12 group were (17.50±4.67) mm、(18.19±5.62) mm、(16.92±5.28) mm、(12.00±4.42) mm respectively. There were significant differences among T10~12 and T1~3 (P<0.01), T4~6 (P<0.01), T7~9 group (P<0.01). (2) Intervals of spinal nerve-lateral costotransverse ligament: average distance was (17.67±3.76) mm. The distances of spinal nerve-lateral costotransverse ligament of T1~3 , T4~6 , T7~9 and T10~12 group were (16.95±3.82) mm、(17.55±3.89) mm、(17.81±3.83) mm、(18.30±3.43) mm, respectively. There was no significant difference between each two groups (P>0.05). Conclusions　It is important to pre-estimate the puncture depth before and during ultrasound-guided thoracic paravertebral nerve block to avoid spinal nerve injury and even spinal anesthesia.