Rand Ethan, Christolias George, Visco Christopher, R Singh Jaspal
Department of Rehabilitation and Regenerative Medicine, Presbyterian Hospital, New York, The United States.
Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, The United States.
Anesth Pain Med. 2016 May 30;6(5):e36607. doi: 10.5812/aapm.36607. eCollection 2016 Oct.
Percutaneous diagnostic and therapeutic procedures are commonly used in the treatment of spinal pain. The success of these procedures depends on the accuracy of needle placement, which is influenced by needle size and shape.
The purpose of this study is to examine and quantify the deviation of commonly used spinal needles based on needle tip design and gauge, using a ballistic gel tissue simulant.
Six needles commonly used in spinal procedures (Quincke, Short Bevel, Chiba, Tuohy, Hustead, Whitacre) were selected for use in this study. Ballistic gel samples were made in molds of two depths, 40mm and 80 mm. Each needle was mounted in a drill press to ensure an accurate needle trajectory. Distance of deflection was recorded for each needle.
In comparing the mean deflection of 22 gauge needles of all types at 80 mm of depth, deflection was greatest among beveled needles [Short Bevel (9.96 ± 0.77 mm), Quincke (8.89 ± 0.17 mm), Chiba (7.71 ± 1.16 mm)], moderate among epidural needles [Tuohy (7.64 ± 0.16 mm) and least among the pencil-point needles [Whitacre (0.73 ± 0.34 mm)]. Increased gauge (25 g) led to a significant increase in deflection among beveled needles. The direction of deflection was away from the bevel with Quincke, Chiba and Short Beveled needles and toward the bevel of the Tuohy and Hustead needles. Deflection of the Whitacre pencil-point needle was minimal.
There is clinical utility in knowing the relative deflection of various needle tips. When a procedure requires a needle to be steered around obstacles, or along non-collinear targets, the predictable and large amount of deflection obtained through use of a beveled spinal needle may prove beneficial.
经皮诊断和治疗程序常用于脊柱疼痛的治疗。这些程序的成功取决于针放置的准确性，而这又受针的尺寸和形状影响。
本研究的目的是使用弹道凝胶组织模拟物，根据针尖设计和规格检查并量化常用脊柱针的偏差。
本研究选用了六种常用于脊柱手术的针（昆克针、短斜面针、千叶针、图伊针、赫斯特德针、惠特克针）。在40毫米和80毫米两种深度的模具中制作弹道凝胶样本。将每根针安装在钻床上以确保针的轨迹准确。记录每根针的偏转距离。
在比较所有类型22号针在80毫米深度处的平均偏转时，斜面针的偏转最大[短斜面针（9.96±±0.77毫米）、昆克针（8.89±±0.17毫米）、千叶针（7.71±±1.16毫米）]，硬膜外针的偏转适中[图伊针（7.64±±0.16毫米）]，铅笔尖针的偏转最小[惠特克针（0.73±±0.34毫米）]。规格增加（25号）导致斜面针的偏转显著增加。昆克针、千叶针和短斜面针的偏转方向远离斜面，而图伊针和赫斯特德针的偏转方向朝向斜面。惠特克铅笔尖针的偏转最小。
了解各种针尖的相对偏转具有临床实用价值。当手术需要针绕过障碍物或沿着非共线目标时，使用斜面脊柱针获得的可预测且较大的偏转可能证明是有益的。
