van Schoor A N, Boon J M, Bosenberg A T, Abrahams P H, Meiring J H
Department of Anatomy: Section of Clinical Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Paediatr Anaesth. 2005 May;15(5):371-7. doi: 10.1111/j.1460-9592.2005.01464.x.
The ilioinguinal/iliohypogastric nerve block is safe, effective and easy to perform in order to provide analgesia for a variety of inguinal surgical procedures in pediatric patients. A relatively high failure rate of 10-25% has been reported, even in experienced hands. The aim of this study was to determine the exact anatomical position of the ilioinguinal and iliohypogastric nerves in relation to an easily identifiable constant bony landmark, the anterior superior iliac spine (ASIS) in neonates and infants. The current ilioinguinal/iliohypogastric nerve block techniques were also evaluated from an anatomical perspective.
Dissections were performed on a sample of 25 infant and neonatal cadavers (mean weight = 2.2 kg; mean height = 45.6 cm). The distance from the ASIS to both the ilioinguinal and iliohypogastric nerves, on a line connecting the ASIS to the umbilicus was carefully measured using a digital caliper. Three techniques, commonly used in clinical practice, were simulated on the anatomical specimens.
The left and right ilioinguinal nerves were closer to the ASIS than previously described, i.e. 1.9 +/- 0.9 mm (mean +/- sd) and 2.0 +/- 0.7 mm, respectively. The mean distance from the left and right iliohypogastric nerves to the ASIS are 3.3 +/- 0.8 mm and 3.9 +/- 1.0 mm, respectively.
We suggest that the high failure rate of the ilioinguinal/iliohypogastric nerve block in this age group could be due to lack of specific spatial knowledge of the anatomy of these nerves in infants and neonates. This cadaver-based study suggests an insertion point closer to the ASIS, approximately 2.5 mm (range: 1.0-4.9) from the ASIS on a line drawn between the ipsilateral ASIS and the umbilicus.
髂腹股沟/髂腹下神经阻滞安全、有效且易于实施，可为小儿患者的各种腹股沟外科手术提供镇痛。即使是经验丰富的医生，据报道该阻滞的失败率也相对较高，为10% - 25%。本研究的目的是确定新生儿和婴儿中髂腹股沟神经和髂腹下神经相对于一个易于识别的恒定骨性标志——髂前上棘（ASIS）的确切解剖位置。还从解剖学角度评估了当前的髂腹股沟/髂腹下神经阻滞技术。
对25具婴儿和新生儿尸体样本（平均体重 = 2.2 kg；平均身高 = 45.6 cm）进行解剖。使用数字卡尺仔细测量在连接ASIS与脐的直线上，从ASIS到髂腹股沟神经和髂腹下神经的距离。在解剖标本上模拟了临床实践中常用的三种技术。
左右髂腹股沟神经比先前描述的更靠近ASIS，即分别为1.9 ± 0.9 mm（平均值 ± 标准差）和2.0 ± 0.7 mm。左右髂腹下神经到ASIS的平均距离分别为3.3 ± 0.8 mm和3.9 ± 1.0 mm。
我们认为该年龄组中髂腹股沟/髂腹下神经阻滞的高失败率可能是由于婴儿和新生儿缺乏对这些神经解剖结构的特定空间知识。这项基于尸体的研究表明，在同侧ASIS与脐之间的连线上，插入点更靠近ASIS，距ASIS约2.5 mm（范围：1.0 - 4.9）。
