腰椎丛阻滞时置针的安全裕度：磁共振成像的解剖学研究。

Safety margin for needle placement during lumbar plexus block: An anatomical study using magnetic resonance imaging.

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.

出版信息

Can J Anaesth. 2019 Mar;66(3):302-308. doi: 10.1007/s12630-018-01280-w. Epub 2018 Dec 19.

DOI:10.1007/s12630-018-01280-w

PMID:30569307

Abstract

PURPOSE

We aimed to provide anatomic characteristics of the lumbar plexus and a safety margin for needle placement during lumbar plexus block in adults.

METHODS

Lumbar spine magnetic resonance images from 377 adults were reviewed. We determined the depth of the lumbar plexus from the needle insertion point for the modified traditional and Capdevila's approaches at the L4 and L5 levels. The relationship of age, height, and body weight with lumbar plexus depth, and the presence of the kidney on the transverse plane at the L4 level were assessed.

RESULTS

The lumbar plexus was deeper at the L5 level than at the L4 level for both approaches (mean difference 3.2 mm [95% confidence interval (CI), 2.4 to 4.0] for the modified traditional approach; mean difference 4.4 mm [95% CI, 3.7 to 5.2] for Capdevila's approach). Eighty-six (22.8%) patients had an L4 transverse process shorter than 40 mm, which implies that the needle may not contact the L4 transverse process with the modified traditional approach. The mean (standard deviation) of safety margins for needle insertion, defined as the distance from the posterior aspect of the L4 transverse process to the anterior margin of the psoas muscle, were 45 (8) and 44 (6) mm, respectively for the modified traditional and Capdevila's approach (mean difference, 0.5 mm; 95% CI, -0.1 to 1.1]). The lumbar plexus depth for each approach at the L4 level was predicted using the following equations: Depth (mm) = 87.24 - 0.36 × height (cm) + 0.69 × weight (kg) for the modified traditional approach (r = 0.37) and Depth (mm) = 86.51 - 0.35 × height (cm) + 0.61 × weight (kg) for Capdevila's approach (r = 0.33). The kidney was observed at the L4 level in 60 (15.9%) patients, with higher incidence in patients over 70 yr and those shorter than 150 cm.

CONCLUSION

The surface anatomic relations of the lumbar plexus found in this study may be useful for performing successful and safe lumbar plexus block.

摘要

目的

旨在为成人腰椎丛阻滞提供腰椎丛的解剖学特征和进针点的安全范围。

方法

回顾了 377 名成年人的腰椎磁共振图像。我们确定了改良传统方法和 Capdevila 方法在 L4 和 L5 水平时，从进针点到腰椎丛的深度。评估了年龄、身高和体重与腰椎丛深度的关系，以及在 L4 水平的横断面上肾脏的存在。

结果

两种方法中，腰椎丛在 L5 水平的深度均大于 L4 水平（改良传统方法的平均差值为 3.2 毫米[95%置信区间（CI），2.4 至 4.0]；Capdevila 方法的平均差值为 4.4 毫米[95%CI，3.7 至 5.2]）。86（22.8%）名患者的 L4 横突小于 40 毫米，这意味着改良传统方法进针时可能无法触及 L4 横突。改良传统方法和 Capdevila 方法的进针安全范围（定义为从 L4 横突后缘到腰大肌前缘的距离）分别为 45（8）和 44（6）毫米（平均差值，0.5 毫米；95%CI，-0.1 至 1.1]）。改良传统方法和 Capdevila 方法在 L4 水平时，腰椎丛的深度可以通过以下方程进行预测：深度（mm）= 87.24-0.36×身高（cm）+0.69×体重（kg）（r=0.37）和深度（mm）= 86.51-0.35×身高（cm）+0.61×体重（kg）（r=0.33）。在 60（15.9%）名患者中观察到 L4 水平的肾脏，在 70 岁以上和身高小于 150cm 的患者中发生率较高。