Reina M A, Pulido P, Castedo J, Villanueva M C, López A, Sola R G
Servicio de Anestesiología y Reanimación, Hospital de Móstoles, Madrid.
Rev Esp Anestesiol Reanim. 2006 Jun-Jul;53(6):363-72.
Epidural fat provides sufficient cushion for the pulsatile movements of the dural sac, protects nerve structures, facilitates the movement of the dural sac over the periosteum of the spinal column during flexion and extension, and forms a pharmacologic reservoir of lipophilic substances. We review epidural fat and related structures, including their development during the fetal period when the epidural space is filled by undifferentiated loose, areolar mesenchymal tissue that surrounds the dural sac. In the adult, epidural fat has a continuous distribution and follows a certain metameric pattern. It is located mainly on the dorsal side of the epidural space, where it is organized in triangular capsules joined to the midline of the ligamentum flavum by a vascular pedicle. We consider the distribution of epidural fat in the axial and sagittal planes; its presence in the anterior, lateral and posterior epidural space; its presence in the cervical, thoracic and lumbar portions of the spinal column; and its characteristics and variations according to differing body habits and sex. Finally, we speculate on the possible anesthetic implications of epidural fat in terms of the pharmacokinetics of drugs injected into the epidural space and the tasks of locating the epidural space and inserting an epidural catheter during anesthetic procedures.
硬膜外脂肪为硬脊膜囊的搏动性运动提供了足够的缓冲，保护神经结构，在脊柱屈伸过程中便于硬脊膜囊在脊柱骨膜上移动，并形成亲脂性物质的药物储存库。我们回顾硬膜外脂肪及相关结构，包括其在胎儿期的发育情况，此时硬膜外间隙被围绕硬脊膜囊的未分化疏松蜂窝状间充质组织所填充。在成年人中，硬膜外脂肪呈连续分布并遵循一定的节段模式。它主要位于硬膜外间隙的背侧，在那里它被组织成三角形囊，通过血管蒂与黄韧带中线相连。我们考虑硬膜外脂肪在轴位和矢状位平面的分布；其在前、外侧和后硬膜外间隙的存在情况；其在脊柱颈段、胸段和腰段的存在情况；以及根据不同身体习惯和性别其特征和变异情况。最后，我们从注入硬膜外间隙药物的药代动力学以及麻醉过程中定位硬膜外间隙和插入硬膜外导管的操作等方面推测硬膜外脂肪可能的麻醉意义。
