Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Pain Med. 2022 Sep 30;23(10):1670-1678. doi: 10.1093/pm/pnac043.
We investigated the thoracic segment corresponding to the inferior margin of the rhomboid major muscle (RMM) using ultrasound (US) to evaluate its potential as a reliable anatomic landmark for segment identification.
A prospective observational study.
An operating room.
Patients who underwent procedures around the thoracic spine.
Four hundred segments corresponding to the RMM's inferior margin were identified through the use of paravertebral sagittal US and confirmed by fluoroscopy in 100 participants in the prone position with upward and downward shoulder rotation, comprising four datasets (up-right, up-left, down-right, and down-left). The US identification of the RMM's inferior margin was dichotomously scored (clear vs ambiguous). Each dataset was divided into two groups (dominant segment group vs remaining segments group), which were compared. Factors relevant to the dominant segment associated with the RMM's inferior border were determined through univariable analyses.
The T6 segment was observed most commonly (59.5%) along the RMM's inferior border on paravertebral sagittal US acquired in the prone position, followed by T5 (25.0%), T7 (12.8%), and T4 (2.7%). The segments corresponding to the RMM remained unchanged by shoulder posture in most participants (n = 74, 74%). The RMM's inferior border was clearly distinguishable in 330 cases (82.5%). When the RMM's inferior border was clearly identified, the corresponding segment was likely to match T6 in all datasets, with odds ratios ranging from 3.24 to 6.2.
The RMM's inferior border over the transverse process corresponded to T6 most frequently on paravertebral sagittal US, and its deep fascia was clearly visible in most cases.
我们通过超声（US）研究了与菱形肌（RMM）下缘相对应的胸椎节段，以评估其作为节段识别可靠解剖标志的潜力。
前瞻性观察研究。
手术室。
接受胸椎周围手术的患者。
100 名患者取俯卧位，肩向上和向下旋转，通过椎旁矢状面 US 共识别出 400 个与 RMM 下缘相对应的节段，并通过透视进行确认，该研究包含四个数据集（右上、左上、右下和左下）。US 对 RMM 下缘的识别进行二分法评分（清晰 vs 模糊）。每个数据集分为两组（优势节段组与剩余节段组），并进行比较。通过单变量分析确定与 RMM 下缘相关的优势节段的相关因素。
在俯卧位获得的椎旁矢状面 US 上，最常观察到 T6 节段（59.5%）沿着 RMM 的下缘，其次是 T5（25.0%）、T7（12.8%）和 T4（2.7%）。在大多数参与者中（n=74，74%），肩的姿势对 RMM 对应的节段没有影响。在大多数情况下（330 例，82.5%），RMM 的下缘在 US 上可清晰分辨。当 RMM 的下缘可清晰识别时，在所有数据集的相应节段都可能与 T6 匹配，优势比范围为 3.24 至 6.2。
在椎旁矢状面 US 上，RMM 横突的下边缘与 T6 最常相对应，并且在大多数情况下其深筋膜都清晰可见。
