Paraskeuopoulos Tilemachos, Saranteas Theodosios, Kouladouros Konstantinos, Krepi Heleni, Nakou Mariza, Kostopanagiotou Georgia, Anagnostopoulou Sophia
Department of Anatomy, University of Athens, School of Medicine, Athens, Greece.
Clin Anat. 2010 Oct;23(7):840-7. doi: 10.1002/ca.21021.
The continuity between the intercostal and paravertebral space has been established by several studies. In this study, the paravertebral spread of a colored dye was attempted with two different ultrasound-guided techniques. The posterior area of the trunk was scanned with a linear probe between the level of the fifth and the seventh thoracic vertebrae in eleven embalmed human cadavers. In the first technique, the probe was placed transversely below the inferior margin of the rib, and a needle was inserted between the internal intercostal membrane and the pleura. In the second technique, the probe was placed longitudinally at the intercostal space 5 cm lateral to the spinous processes, and the needle was inserted between the internal intercostal membrane and the pleura. In both techniques, 1 ml of methylene blue was injected, and both the intercostal and paravertebral spaces were prepared. In total, 33 injections were performed: 19 with the transverse technique and 14 with the longitudinal technique. Successful spread of the dye to the thoracic paravertebral space was recorded in 89.5% cases using the transverse technique and 92.8% cases using the longitudinal technique. No intrapleural spread of the dye was recorded in either technique. Ultrasound-guided injection into the intercostal space may offer an alternative approach to the thoracic paravertebral space.
多项研究已证实肋间间隙与椎旁间隙之间存在连续性。在本研究中，尝试采用两种不同的超声引导技术使一种染色剂在椎旁扩散。使用线性探头在11具防腐处理的人体尸体的第五和第七胸椎水平之间对躯干后部进行扫描。在第一种技术中，探头横向置于肋骨下缘下方，将针插入肋间内膜与胸膜之间。在第二种技术中，探头纵向置于距棘突外侧5 cm的肋间间隙处，将针插入肋间内膜与胸膜之间。在两种技术中均注入1 ml亚甲蓝，并对肋间间隙和椎旁间隙进行处理。总共进行了33次注射：横向技术19次，纵向技术14次。使用横向技术时，89.5%的病例记录到染色剂成功扩散至胸段椎旁间隙；使用纵向技术时，92.8%的病例记录到染色剂成功扩散至胸段椎旁间隙。两种技术均未记录到染色剂向胸腔内扩散。超声引导下向肋间间隙注射可能为进入胸段椎旁间隙提供一种替代方法。
