椎旁胸神经阻滞穿刺点定位的应用解剖学研究

目的为椎旁胸神经阻滞穿刺的定位提供解剖学资料。方法将胸神经和椎板外侧缘的交叉点设为靶点，测量靶点所在水平面到上位胸椎棘突中点水平面之间距离、靶点到正中线距离以及靶点到皮肤距离。结果（1）靶点到各自上一椎体棘突中点平面距离：T1-3靶点为20．3±4．1mm，T4-6靶点为5．1±3．2mm，T7-9靶点为5．3±2．4mm，T10-12靶点为20．6±5．0mm。（2）T7离正中线最近为15．1±3．8mm，向上或向下逐渐变宽，在T1处达20．6±4．6mm，在T12处达19．1±7．3mm。（3）靶点到皮肤距离：T5离皮肤距离最近，其距离为43．3±3．1mm向上或向下逐渐增宽，在T1处达51．4±4．1mm，在T12处达49．4±5．0mm，其平均值为3．5±5mm。结论椎旁胸神经可以经上位棘突准确定位。

The Anatomical Study on Puncturing Site of Thoracic Paravertebral Nerve Block

Objective To provide anatomic data of thoracic paravertebral nerve block. Methods Ten cases of cadavers with normal thoracic spines were used in this study. We named the cross point which thoracic nerve in the paravertebral space crossed with lateral edge of laminae of vertebra the target point. The distances between the target point and horizontal plane which the spinous process of the cephalad thoracic vertebra in, and the median sagittal plane, and all skin plane were measured. Results ①The vertical distance between the target point and the horizontal plane which pass through the spinous process of the cephalad thoracic vertebra of T1-3, T4-6, T7-9, T10-12 nerves is 20. 3±4. 1 ram,5.1±3.2 mm, 5.3±2.4 mm, 20.6±5.0 ram; ②Among the target point of all thoracic nerves, T7 is the nearest one to the median sagittal plane, whose distance is 15.1± 3.8 mm. Distance between the target point and the median sagittal plane of T1 is 20.6 ±4. 6 mm. The distance of T12 is 19.1±7.3 mm;③Distance between the target point and all skin plane of all thoracic nerves shows an decreasing and then increasing tendency. T5 is the nearest one to the skin, whose distance is 43. 3±3. 1mm. While the distance of T1 and T12 is 51.4±4.1 mm and 49.4±5.0 mm respectively. Conclusions The accurate location of thoracic nerves can be determined according to the the upper spinous process nearby the thoracic vertebrae.