前锯肌间隙阻滞的解剖学观察及其临床意义

发布时间：2018-03-19 03:21

本文选题：前锯肌间隙　切入点：美兰　出处：《中国临床解剖学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的观察测量前锯肌间隙美兰溶液扩散范围及神经分布,为该间隙神经阻滞提供解剖学依据。方法选用4具尸体,应用超声引导技术,采用Blanco穿刺入路,在胸壁两侧腋中线4、5肋间,注入含美兰染料的液体(0.4 ml/kg)至前锯肌间隙,约10 min后逐层分离至该间隙,观察美兰液体的扩散范围、染料沉积后界限以及该范围内的神经分布。结果观察8侧前锯肌,逐层掀开胸大肌和胸小肌后,清晰显露前锯肌间隙的蓝染区域及区域内蓝染的2~6肋间神经的外侧皮支、胸长神经和胸背神经。中位数M(P25,P75)描述8个前锯肌筋膜间隙注射扩散范围测量结果,腋前线11.35(10.45,12.15)cm,腋中线12.6(12.12,13.15)cm,腋后线11.1(10.70,12.05)cm,平乳头线9.8(9.12,10.65)cm。头侧扩散至第2肋腋前线占75%,腋中线占87.5%,腋后线占87.5%;扩散至第3肋腋前线占25%,腋中线占12.5%,腋后线占12.5%。结论前锯肌间隙美兰溶液扩散范围解剖测量研究提示临床应用此方法进行前锯肌间隙神经阻滞,可阻滞前锯肌间隙内的2~6肋间神经外侧皮支、胸长神经和胸背神经,满足胸前外侧壁手术的麻醉和镇痛。
[Abstract]:Objective to observe and measure the diffusion range and nerve distribution of methylene blue solution in anterior serratus space so as to provide anatomic basis for nerve block in the space. Methods four cadavers were selected and Blanco puncture approach was used to guide 4 cadavers. In the intercostal space of the axillary midline on both sides of the chest wall, a liquid containing methylene dye (0.4 ml / kg) was injected into the space of the anterior serratus. After about 10 min, the space was separated layer by layer, and the diffusion range of the liquid was observed. Results after 8 sides of serratus anterior muscle and pectoralis minor muscle were opened layer by layer, the blue-stained area and the lateral cutaneous branch of the 26 intercostal nerves in the space of serratus anterior muscle were clearly revealed. Median Mannus P25 P75) describes the results of diffusive range measurements of 8 anterior serratus interfascial injection, the median of which is the median of the thoracic nerve and the dorsal thoracic nerve. The axillary front 11.35 ~ 10.45 ~ 12.15 cm, the axillary midline 12.6 ~ 12.12 ~ 13.15 cm, the posterior axillary line 11.1 ~ 10.70 ~ 12.05 cm, the flat nipple line 9.8 ~ 9.12 ~ 10.65 cm, the head spreading to the front of the second costal axillary line 75 ~ 75 cm, the midaxillary line 87.5, the posterior axillary line 87.5; the diffusive line to the third rib axillary front 25; the middle axillary line 12.5m; the posterior axillary line 12.5. conclusion the anterior serratus muscle interspace is 12.5. The anatomic measurement of solution diffusion range suggested that this method could be used to block the anterior serratus space nerve. It can block the lateral cutaneous branch of intercostal nerve, long thoracic nerve and thoracic dorsal nerve in the space of anterior serratus muscle, which can be used for anaesthesia and analgesia of anterolateral thoracic wall operation.
【作者单位】：长治医学院麻醉学系;
【基金】：山西省高等学校大学生创新创业项目(2015308) 山西省高等学校特色专业建设项目(201509) 山西省高等学校教学改革项目(2011073)
【分类号】：R322

【相似文献】