Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
Reg Anesth Pain Med. 2013 Sep-Oct;38(5):391-7. doi: 10.1097/AAP.0b013e31829e52cc.
Ultrasound imaging of the anatomy relevant for lumbar plexus block (LPB) is challenging because of its deep anatomic location and the "acoustic shadow" of the overlying transverse processes. A paramedian transverse scan (PMTS) of the lumbar paravertebral region with the ultrasound beam being insonated through the intertransverse space (ITS) and directed medially toward the intervertebral foramen (PMTS-ITS) may overcome the problem of the "acoustic shadow" and allow clear visualization of the anatomy relevant for LPB. This study assessed the feasibility of using PMTS-ITS for imaging the anatomy relevant for LPB in healthy volunteers.
Thirty young volunteers underwent a PMTS-ITS of the right lumbar paravertebral region. The sonoanatomy was defined in corresponding cadaver anatomic sections and magnetic resonance images. Visibility of the paravertebral structures in the sonograms was assessed by 4 independent observers using a 4-point Likert scale (0, not visible; 1, hardly visible; 2, well visible; 3, very well visible), and the mean total ultrasound visibility score (UVS; maximum score possible, 30) was determined. Overall ultrasound visibility was judged as good if the total UVS was greater than 20, average if it was 10 to 20, and poor if it was less than 10.
Ultrasound imaging of the right lumbar paravertebral region at the L3-L4-L5 vertebral level was successfully performed through the PMTS-ITS scan window in all volunteers studied. The lumbar nerve root, lumbar paravertebral space, lumbar plexus, and the psoas compartment were delineated in 57%, 27%, 57%, and 87% of volunteers, respectively. Overall ultrasound visibility of the lumbar paravertebral structures was judged as "good" (mean [SD] total UVS, 20.4 [3]).
A PMTS-ITS can be used to image the sonoanatomy relevant for LPB including the lumbar nerve root, lumbar paravertebral space, lumbar plexus, and the psoas compartment.
由于腰椎丛阻滞（LPB）的解剖位置较深，且上方横突形成“声影”，因此对其进行超声成像具有一定挑战性。通过椎间空间（ITS）对腰椎旁区域进行旁正中横切面（PMTS）扫描，并使超声束向椎间孔内侧发射，可能会克服“声影”问题，并可清晰显示 LPB 相关解剖结构。本研究评估了 PMTS-ITS 用于成像健康志愿者 LPB 相关解剖结构的可行性。
30 名年轻志愿者接受了右侧腰椎旁 PMTS-ITS 检查。对相应的尸体解剖切片和磁共振图像进行了 Sono 解剖学定义。4 位独立观察者使用 4 分 Likert 量表（0，不可见；1，几乎不可见；2，可见；3，非常可见）评估声像图中椎旁结构的可见度，并确定平均总超声可视性评分（UVS；最大得分 30）。如果总 UVS 大于 20，则认为整体超声可见性良好，如果总 UVS 为 10 到 20，则认为平均，若总 UVS 小于 10，则认为较差。
在所有研究志愿者中，通过 PMTS-ITS 扫描窗成功进行了右侧 L3-L4-L5 椎骨水平腰椎旁区的超声成像。在 57%、27%、57%和 87%的志愿者中分别描绘了腰椎神经根、腰椎旁间隙、腰椎丛和腰大肌间隙。腰椎旁结构的整体超声可见性被判定为“良好”（平均[SD]总 UVS，20.4[3]）。
PMTS-ITS 可用于成像 LPB 相关的 Sono 解剖结构，包括腰椎神经根、腰椎旁间隙、腰椎丛和腰大肌间隙。
