Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR, People's Republic of China.
Reg Anesth Pain Med. 2012 Jan-Feb;37(1):60-6. doi: 10.1097/AAP.0b013e318232eb92.
Currently, there are limited data on the use of 3-dimensional ultrasound to image peripheral nerves. We undertook this imaging study to determine the feasibility of using 3-dimensional ultrasound imaging to delineate the anatomy of the sciatic nerve.
After research ethics committee approval and written informed consent, 4 healthy young adult male volunteers underwent 3-dimensional ultrasound scan of the sciatic nerve. A Voluson 730 Expert (GE Healthcare, Austria) with a broadband convex volume transducer (4-8.5 MHz) was used to scan the sciatic nerves at 3 levels: the subgluteal space, posterior aspect of the midthigh, and at the apex of the popliteal fossa. Three-dimensional volumetric ultrasound scan of the sciatic nerve was performed with the transverse plane as the data acquisition plane. The acquired 3-dimensional volumes were also rendered using a 3-dimensional volume-rendering software and displayed as a multiplanar image or as a "niche" display.
The right sciatic nerve was successfully scanned using the broadband convex volume transducer in all 4 volunteers. A distinct perineural space was identified around the sciatic nerve from the subgluteal space to the level of the popliteal fossa. Proximally, the sciatic nerve was visualized in a hypoechoic "subgluteal space" between the epimysium of the gluteus maximus and the quadratus femoris muscle. More distally, a hypoechoic "perineural" space was identifiable between the sciatic nerve and the hamstrings muscles. The niche view demonstrated the cranial extension of the subgluteal space, as an intermuscular tunnel or as a conduit for the sciatic nerve.
We have demonstrated that it is feasible to perform 3-dimensional ultrasound imaging of the sciatic nerve. The anatomic information obtained is more detailed than that with a 2-dimensional scan, which provides better insight into the spatial relationship of the sciatic nerve with its surrounding structures. A distinct "perineural space" was also identified alongside the course of the sciatic nerve, which may play a significant role in sciatic nerve blockade.
目前，关于使用三维超声成像来显示外周神经的资料有限。我们进行了这项成像研究，以确定使用三维超声成像来描绘坐骨神经解剖结构的可行性。
在获得研究伦理委员会批准和书面知情同意书后，4 名健康的年轻成年男性志愿者接受了坐骨神经的三维超声扫描。使用 Voluson 730 Expert（GE Healthcare，奥地利）的宽带凸阵容积探头（4-8.5 MHz），在 3 个水平对坐骨神经进行扫描：臀下间隙、大腿后外侧和腘窝顶。以横切面作为数据采集平面，对坐骨神经进行三维容积超声扫描。获取的三维体积也使用三维容积渲染软件进行渲染，并显示为多平面图像或“龛”显示。
在所有 4 名志愿者中，均成功使用宽带凸阵容积探头扫描右侧坐骨神经。从臀下间隙到腘窝水平，在坐骨神经周围识别出一个明显的神经周围间隙。在近端，坐骨神经在臀大肌的筋膜和股方肌之间的低回声“臀下间隙”中可见。更远处，在坐骨神经和腘绳肌之间可识别出低回声“神经周围”间隙。龛位视图显示了臀下间隙的颅侧延伸，作为坐骨神经的肌间隧道或导管。
我们已经证明了对坐骨神经进行三维超声成像的可行性。所获得的解剖学信息比二维扫描更详细，这提供了对坐骨神经与其周围结构的空间关系的更好理解。在坐骨神经的走行过程中也识别出一个明显的“神经周围间隙”，这可能在外周神经阻滞中发挥重要作用。
