Sitzman B T, Uncles D R
Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Anesth Analg. 1996 Feb;82(2):297-301. doi: 10.1097/00000539-199602000-00014.
Although the use of fine-gauge spinal needles reduces the incidence of postdural puncture headache, they are associated with increased risk of placement failure as a result of deflection and bending. This in vitro study quantifies spinal needle deflection from the axis of insertion with respect to needle type, gauge, and tip bend. In addition to straight-tip needles, those with standardized 5 degrees and 10 degrees tip bends were studied. The purpose was to examine the effect of tip bend, which has been described with small gauge spinal needles after bony contact, on needle path deflection. Needles studied included Quincke (Q), Sprotte (S), and Whitacre (W) in sizes ranging from 18-gauge to 29-gauge. Needles were inserted perpendicularly into porcine paraspinous muscle followed by radiologic investigation. Measurements of needle deflection from the axis of insertion at depths of 20, 40, and 60 mm were performed in a blinded fashion. Straight-tip Q needle deflection, but not W or S, was correlated with gauge and depth of insertion. Although there were differences within needle type groups, needle deflection was generally correlated with the degree of tip bend. We conclude that spinal needle deflection is dependent on the type of needle (W < S < Q), and that the magnitude of deflection is related to gauge (large < small) and tip bend (straight < 5 degrees < 10 degrees).
尽管使用细规格脊髓穿刺针可降低硬膜穿刺后头痛的发生率，但由于针的偏斜和弯曲，其导致穿刺失败的风险增加。这项体外研究量化了脊髓穿刺针相对于针的类型、规格和针尖弯曲度在插入轴线上的偏斜情况。除了直尖针外，还研究了具有标准化5度和10度针尖弯曲的针。目的是研究在与骨质接触后已在细规格脊髓穿刺针中描述过的针尖弯曲对针道偏斜的影响。所研究的针包括18号至29号的昆克（Q）针、斯普罗特（S）针和惠特克（W）针。将针垂直插入猪的椎旁肌，随后进行放射学检查。以盲法测量在20、40和60毫米深度处针相对于插入轴线的偏斜情况。直尖Q针的偏斜与规格和插入深度相关，而W针和S针则不然。尽管在针型组内存在差异，但针的偏斜通常与针尖弯曲程度相关。我们得出结论，脊髓穿刺针的偏斜取决于针的类型（W < S < Q），并且偏斜程度与规格（大号 < 小号）和针尖弯曲度（直 < 5度 < 10度）有关。
