Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 1514, Toronto, ON M5G 1X5, Canada.
Can J Anaesth. 2011 Dec;58(12):1069-74. doi: 10.1007/s12630-011-9587-2. Epub 2011 Oct 5.
Precise localization of the cervicothoracic vertebral levels is essential for accurate placement of epidural catheters. Previous studies have demonstrated that anesthesiologists are inaccurate when using surface anatomy to locate lumbar vertebral levels. Our study was designed to determine the agreement between anatomical landmarks and the ultrasound technique in identifying the T7-8 and C7-T1 intervertebral spaces.
Adult healthy volunteers were assessed for the identification of cervicothoracic intervertebral spaces, initially in the anatomic position (AP)-upright, back straight, arms at the sides, and palms forward and then in the epidural position (EP) routinely used for epidural placement-seated, back arched, neck flexed, and arms across the chest. The T7 and C7 spinous processes were identified by one investigator using the inferior tip of the scapula and the vertebra prominens, respectively, as landmarks. Ultrasound was then used by a second investigator to identify the intervertebral spaces corresponding to the previously marked levels.
Fifty-five volunteers (23 males, 32 females) were recruited. The T7-8 intervertebral space determined by ultrasound coincided with the landmark findings in the AP and in the EP in 18% and 36% of the cases, respectively. The C7-T1 interspace identified by ultrasound corresponded with the surface landmarks in the AP and in the EP in 53% and 58% of the cases, respectively. In most cases, when the surface landmark and ultrasound findings of T7-8 did not agree, the surface landmark identified a lower interspace than ultrasound.
Identification of cervicothoracic intervertebral spaces by surface landmarks corresponded poorly with their identification using ultrasound. However, compared with the upright position, agreement in identifying the T7-8 interspace improved in the epidural position.
精确定位颈胸椎体水平对于准确放置硬膜外导管至关重要。先前的研究表明，麻醉师在使用体表解剖定位腰椎水平时不准确。我们的研究旨在确定解剖标志与超声技术在识别 T7-8 和 C7-T1 椎间空间方面的一致性。
对成年健康志愿者进行颈胸椎间空间的识别评估，最初采用解剖位（AP）-直立、背部挺直、手臂放在身体两侧、手掌向前，然后采用硬膜外常规使用的仰卧位（EP）-背部拱起、颈部弯曲、手臂交叉于胸前。由一名研究人员使用肩胛下角和椎体隆凸分别确定 T7 和 C7 棘突作为标志。然后由第二名研究人员使用超声识别与先前标记水平相对应的椎间空间。
共招募了 55 名志愿者（23 名男性，32 名女性）。超声确定的 T7-8 椎间空间在 AP 和 EP 中的比例分别为 18%和 36%与标志定位相符。超声识别的 C7-T1 椎间空间在 AP 和 EP 中的比例分别为 53%和 58%与体表标志相符。在大多数情况下，当体表标志和 T7-8 的超声检查结果不一致时，体表标志识别的椎间空间低于超声检查。
体表标志识别颈胸椎间空间与超声识别结果不一致。然而，与直立位相比，在硬膜外位，识别 T7-8 椎间空间的一致性有所提高。
