Williams Christi L, Curfman Sue E, Lindsley Stacey R, Falyar Christian R, McConnell Ryan C
Physical Therapy Belmont University.
Nurse Anesthesia Middle Tennessee School of Anesthesia.
Int J Sports Phys Ther. 2024 Oct 1;19(10):1238-1243. doi: 10.26603/001c.123477. eCollection 2024.
Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas.
The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction.
Descriptive Cadaveric study.
The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal.
A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior.
The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented.
Level IV.
干针疗法已成为治疗肌肉骨骼疼痛的一种常用治疗手段。虽然严重不良事件一般很少见，但在脊柱和胸部等易损部位报告的此类事件可能很严重，因此有必要对这些部位及其周围的安全技术进行进一步研究。
本研究旨在重复威廉姆斯等人采用的方法，但采用下内侧多裂肌干针技术，以确定干针能否穿透黄韧带（LF）并在胸腰段交界处进入椎管。
描述性尸体研究。
在俯卧位的尸体上进行该操作。在超声引导下进针，以确定从T12棘突外侧插入并向下内侧方向进针的0.30×40mm干针能否穿透黄韧带并进入椎管。
在T12棘突外侧1.9cm处插入的0.30×40mm干针能够穿过T12和L1椎板之间的间隙，穿透黄韧带，并以向内33度、向下18度的下内侧进针角度进入椎管。
本研究结果表明，采用下内侧技术时，干针在胸腰段交界处进入椎管是可行的。这些发现支持了超声引导在干针疗法培训和临床实践中的潜在作用，尤其是在已记录有安全问题的区域。
四级。
