Zhao Qianqian, Huang Kechang, An Jianxiong, Fang Qiwu, Wen Hui, Qian Xiaoyan, Cope Doris K, Williams John P
Department of Anesthesiology, Weifang Medical University, Weifang City, China.
Pain Physician. 2014 Mar-Apr;17(2):163-8.
A few studies on the depth from the skin to the cervical epidural space (DSES) have been reported from the United States, South Korea, Japan, and Taiwan. There are no published reports from mainland China.
The goal of this study was to collect standard data on Chinese adults from mainland China in a large medical center with a wide geographical range of patients.
A prospective study.
Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Aviation General Hospital of China Medical University.
The survey included 410 patients. Measurements were made of DSES, the dural sac, and the spinal cord by automatic measuring ruler on transverse and sagittal images of the cervical spine at the C5-6, C6-7, C7-T1, T1-2, and T2-3 intervertebral space obtained by magnetic resonance imaging (MRI). We also obtained the width of the epidural space by measuring the distance from the (LF) to the dural sac.
DSES at C5-6, C6-7, C7-T1, T1-2, and T2-3, respectively, was 4.69 ± 0.84 cm, 5.14 ± 0.98 cm, 5.56 ± 1.03 cm, 5.81 ± 0.94 cm, and 5.76 ± 0.86 cm on T2W (weighted) MRIs obtained in the sagittal plane (mean ± SD). The distance at C5-6, C6-7, and C7-T1 in transverse images was 4.67 ± 0.86 cm, 5.18 ± 1.02 cm, and 5.55 ± 0.97 cm, respectively. All measured distances from the skin to the epidural space were significantly greater in men than in women. Multivariate regression analysis revealed significant partial correlation between DSES and (BMI).
Limitations include the absence of healthy individuals as well as the influence of the difference in neck positioning during the MRI examination vs. active epidural puncture.
DSES varied with the cervical intervertebral level in those patients studied from the population of mainland China. The greatest DSES was noted at C7-T1 in men and T1-2 in women, and the least was at C5-6 in both men and women. DSES had a significant relationship with neck circumference and BMI in both genders. We suggest that the DSES be measured with MRI before performing epidural puncture. The lower cervical and upper thoracic intervertebral spaces appear to provide a greater margin of safety for epidural puncture.
美国、韩国、日本和台湾地区已报道了一些关于皮肤至颈段硬膜外间隙深度（DSES）的研究。中国大陆尚无相关发表报告。
本研究旨在收集中国大陆大型医疗中心广泛地理区域患者的中国成年人标准数据。
一项前瞻性研究。
中国医科大学航空总医院麻醉科、疼痛医学与重症医学科。
该调查纳入410例患者。通过磁共振成像（MRI）获得颈椎在C5 - 6、C6 - 7、C7 - T1、T1 - 2和T2 - 3椎间隙的横断位和矢状位图像，使用自动测量尺测量DSES、硬脊膜囊和脊髓。我们还通过测量从（LF）到硬脊膜囊的距离获得硬膜外间隙的宽度。
在矢状面获得的T2加权（加权）MRI上，C5 - 6、C6 - 7、C7 - T1、T1 - 2和T2 - 3水平的DSES分别为4.69±0.84cm、5.14±0.98cm、5.56±1.03cm、5.81±0.94cm和5.76±0.86cm（均值±标准差）。横断位图像上C5 - 6、C6 - 7和C7 - T1水平的距离分别为4.67±0.86cm、5.18±1.02cm和5.55±0.97cm。所有测量的从皮肤到硬膜外间隙的距离男性均显著大于女性。多因素回归分析显示DSES与（BMI）之间存在显著的部分相关性。
局限性包括缺乏健康个体以及MRI检查与硬膜外穿刺时颈部位置差异的影响。
在中国大陆研究人群中，DSES随颈椎椎间水平而变化。男性中C7 - T1水平的DSES最大，女性中T1 - 2水平的DSES最大，男性和女性中C5 - 6水平的DSES最小。DSES在两性中均与颈围和BMI存在显著关系。我们建议在进行硬膜外穿刺前用MRI测量DSES。下颈椎和上胸椎椎间间隙似乎为硬膜外穿刺提供了更大的安全 margin 。 （原文此处“margin”可能有误，推测可能是“margin of safety”即安全 margin ，翻译时按此理解翻译，具体需结合专业知识进一步确认）
