臂内侧入路臂丛阻滞麻醉的解剖学基础

Brachial plexus block anesthesia via medial ann approach: anatomical basis

目的:为臂内侧入路臂丛阻滞麻醉提供解剖学基础。方法:①尸体解剖观测臂内侧血管神经鞘;②模拟注射造影剂后X线造影和CT扫描观察造影剂扩散范围;③选择合适病例临床应用。结果:①臂内侧血管神经鞘与腋鞘相通;②臂内侧血管神经鞘注射有色液体后,鞘内各主要神经干均被染色;③造影剂可以于臂内侧鞘内向上、向下扩散;④临床应用225例,成功211例,成功率93.8％。结论:臂内侧入路臂丛阻滞麻醉具有操作简便,成功率高,无严重并发症的优点,特别适用于前臂及手部手术麻醉。

Objective: To provide the anatomical basis for brachial plexus block anesthesia via medial arm approach. Methods: (1) Vasculoneural sheaths were observed and measured through autopsy; (2) The contrast agent was injected and its diffusion was examined by X-ray imaging and CT scanning; (3) suitable cases were selected for clinical application. Results: (1) Vasculoneural sheaths and axillary sheaths were found to be interconnected in the medial arm; (2) the main nerve-trunks in the sheaths were all stained with the agent; (3) the agent could spread up and down within the medial arm sheaths; (4) 211 among the 225 cases of clinical application succeeded in anesthesia, with the successful rate of 93.8%. Conclusions: The medial arm approach to block brachial plexus is convenient and has a high successful rate but no severe complications, especially applicable to operative anesthesia of forearms and hands.