多层螺旋CT在骶管阻滞麻醉中的临床应用

Clinical value of multislice spiral CT in caudal block

目的为骶管阻滞麻醉骶管裂孔穿刺点体表定位、进针方向及深度探索一种新的方法。方法回顾性对8例盆腔扫描病人进行三维重建,测量骶管裂孔至拟注药点的距离及骶管裂孔大小;骶骨表面重建后对骶管裂孔、骶管的形状进行评估,确定进针方向。结果全部病人经骶骨表面重建后能通过各种角度对骶管裂孔进行观察并测量骶管裂孔的大小,从骶正中嵴将骶骨切除一半后能对骶管的形状及走行进行精确的观察并准确测出了骶管裂孔至注药点的距离。利用上述数据术前在病人体表进行了准确定位,并成功实施了麻醉。结论本方法可帮助医生对骶管裂孔进针方向、进针深度提供准确的数据,显著提高了麻醉手术的成功率,避免了给患者可能带来的副损伤,同时还可进行术前麻醉模拟训练。

Objective To explore a new method for body surface orientation of the puncture site, determination of the direction of the needling and puncture depth for caudal block. Methods Three-dimensional reconstruction of the pelvis was performed in 8 cases for measuring the distances between the sacral hiatus and the planned site of anesthetic delivery and the size of the sacral hiatus. After image processing with the technique of shaded surface display （SSD）, the shapes of sacral hiatus and sacral tube were evaluated. Results Three-dimensional reconstruction of the pelvis in the 8 cases allowed clear view from any directions of the sacral hiatus and sacral tube and accurate measurement of the size of the sacral hiatus. After simulated cutting of half of the rumpbone, the distances between the sacral hiatus and the drug site were accurately measured. With these measurements, accurate preoperative localization of the puncture site on the skin was achieved and the anesthesia was successful in all the cases. Conclusions This technique can provide accurate data for localization of the puncture site on the skin and determination of the direction of the needling and the puncture depth for caudal block to increase the successful rate of anesthesia, lower the operative risks and allow simulated operative training.