Rocco A G, Palombi D, Raeke D
Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Reg Anesth. 1995 Jan-Feb;20(1):13-9.
To acquire an accurate knowledge of the relationship of the sympathetic chain to the vertebral column.
In dissections on 65 cadavers the authors located the sympathetic chain and its ganglia in three dimensions with respect to the vertebral column: cephalad-caudad in the sagittal plane; ventrally and laterally in the horizontal (axial) plane. The relationship of the sympathetic chain to the psoas muscle and that of the psoas muscle to the vertebral column was also established. Transparent markers were placed at each disk space and colored markers at each grossly recognizable ganglion. Photographs and measurements were then made.
In the sagittal plane, the lumbar ganglia were most often present opposite the middle of the body of the third vertebra and at the disks above and below. In the horizontal plane, the ganglia lay from 0 to 0.5 cm posterior to the anterior border of the third lumbar vertebra and 1.8 to 3.0 cm laterally from the center of the third lumbar vertebra. The sympathetic chain always lay anterior to the psoas muscle.
Although the location of the ganglia is quite variable, the best approach for sympathetic block is to advance the needle paravertebrally through the fascia of the psoas muscle slightly cephalad to the midpoint of the body of L3.
准确了解交感神经链与脊柱的关系。
对65具尸体进行解剖，作者在三维空间中确定交感神经链及其神经节相对于脊柱的位置：在矢状面为头侧-尾侧；在水平面（轴面）为腹侧和外侧。还确定了交感神经链与腰大肌的关系以及腰大肌与脊柱的关系。在每个椎间盘间隙放置透明标记物，在每个明显可识别的神经节处放置彩色标记物。然后进行拍照和测量。
在矢状面，腰神经节最常位于第三椎体中部相对处以及其上方和下方的椎间盘处。在水平面，神经节位于第三腰椎前缘后方0至0.5厘米处，且从第三腰椎中心向外1.8至3.0厘米处。交感神经链总是位于腰大肌前方。
尽管神经节的位置变化很大，但交感神经阻滞的最佳进针方法是在椎旁经腰大肌筋膜向L3椎体中点稍头侧进针。
