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颈椎和胸高位黄韧带的解剖变异。

Anatomic variations of cervical and high thoracic ligamentum flavum.

机构信息

Department of Anatomy, Jeju National University, School of Medicine, Jeju, Korea.

Department of Anesthesiology and Pain Medicine, Jeju National University, School of Medicine, Jeju, Korea.

出版信息

Korean J Pain. 2014 Oct;27(4):321-5. doi: 10.3344/kjp.2014.27.4.321. Epub 2014 Oct 1.

DOI:10.3344/kjp.2014.27.4.321
PMID:25317280
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4196496/
Abstract

BACKGROUND

Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers.

METHODS

Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly.

RESULTS

The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum.

CONCLUSIONS

The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.

摘要

背景

硬膜外阻滞广泛应用于急性和慢性疼痛的治疗。在确定硬膜外间隙时，常采用阻力消失技术。黄韧带的不连续性可能增加无法识别硬膜外间隙的风险。本研究旨在研究防腐尸体颈椎和胸上段黄韧带的解剖变异。

方法

获得 15 具人体尸体的脊柱标本。在椎弓根与椎弓分离后，去除硬脊膜和硬膜外结缔组织。直接从前部检查 C3 至 T6 的黄韧带。

结果

C3 至 T2 之间黄韧带的中线间隙发生率为 87%-100%。低于此水平的发生率降低，在 T4-T5 最低（8%）。在有间隙的水平中，黄韧带的尾部三分之一处的间隙位置比中部或头部更常见。

结论

颈椎和胸上段黄韧带经常有中线间隔，具有不同的特征，尤其是在椎间空间的尾部。因此，黄韧带在这些椎骨水平上并不总是作为可感知的硬膜外空间识别屏障可靠。此外，将针头插入椎间空间的头部比插入尾部更有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d38/4196496/9f36f93b7f12/kjpain-27-321-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d38/4196496/22b034d61bd8/kjpain-27-321-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d38/4196496/9f36f93b7f12/kjpain-27-321-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d38/4196496/22b034d61bd8/kjpain-27-321-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d38/4196496/9f36f93b7f12/kjpain-27-321-g002.jpg

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