Berthier Francis, Lepage Daniel, Henry Yann, Vuillier Fabrice, Christophe Jean-Luc, Boillot Annie, Samain Emmanuel, Tatu Laurent
Department of Anaesthesiology and Intensive Care Medecine, Universitary Hospital of Besancon, 3 Bvd Alexander Flemming, 25000, Besancon, France.
Surg Radiol Anat. 2010 Mar;32(3):299-304. doi: 10.1007/s00276-009-0539-2. Epub 2009 Aug 8.
Ultrasound (US) has emerged in the field of regional anaesthesia in the past few years, as it allows physicians to simultaneously see the needle, the targeted nerves, and the vessels to avoid. Nevertheless, anatomical knowledge is essential for identifying all of the structures seen on the US screen. US also allows an in vivo approach to the variations of nerves and vessels. The aim of this study was to describe the anatomical structures of the axilla through a dissection, an anatomical section and US images performed during daily regional anaesthesia. This work will also discuss the usefulness of US in studying anatomical variations of vasculonervous structures.
The axillary region of an embalmed adult cadaver was dissected in the department of Anatomy, and anatomical sections of another embalmed and frozen cadaver were also performed. During the same period, fortuitous anatomical variations discovered during daily routine axillary US-guided nerve blocks were recorded in the department of Anaesthesiology.
The anatomical dissection and sections allowed correlations to be made and structures to be identified on the US images. The most frequent anatomical variations found were double axillary artery, numerous axillary veins, variant location of the musculocutaneous nerve and posterior location of the brachial plexus in relation to the axillary artery.
Anatomical knowledge is of major importance for US-guided regional anaesthesia. US scan offers a new approach to anatomical variations of the vasculonervous bundle at the junction of the axilla and the upper arm.
在过去几年中，超声（US）已出现在区域麻醉领域，因为它能让医生同时看到穿刺针、目标神经和需避开的血管。然而，解剖学知识对于识别超声屏幕上看到的所有结构至关重要。超声还能对神经和血管的变异进行活体观察。本研究的目的是通过解剖、解剖切片以及在日常区域麻醉过程中进行的超声图像，描述腋窝的解剖结构。这项工作还将讨论超声在研究血管神经结构解剖变异方面的实用性。
在解剖学系对一具防腐处理后的成年尸体的腋窝区域进行解剖，并对另一具防腐处理且冷冻后的尸体进行解剖切片。同时，在麻醉学系记录日常腋窝超声引导神经阻滞过程中偶然发现的解剖变异情况。
解剖和切片使得能够在超声图像上建立关联并识别结构。发现的最常见解剖变异为双腋动脉、多条腋静脉、肌皮神经位置变异以及臂丛相对于腋动脉的后方位置。
解剖学知识对于超声引导的区域麻醉至关重要。超声扫描为腋窝与上臂交界处血管神经束的解剖变异提供了一种新的观察方法。
