颈丛深支一点法阻滞相关结构的研究

Study on the structures related to the blocking of the deep branch in cervical plexus with one point method

目的:对颈丛神经阻滞入路相关结构及其毗邻关系进行解剖观测,为颈丛神经阻滞入路和预防并发症的发生提供解剖学基础。方法:对50侧尸体颈部与颈丛神经阻滞入路相关结构及其毗邻关系进行了解剖观测。结果:颈丛深支穿刺进针深度:皮肤至第4颈椎横突距离(在前斜角肌与中斜角肌平第4颈椎垂直刺入皮肤)左侧21.0±0.4(18.0—24.0)mm,右侧20.5±0.5(19.0—23.5)mm。获得了与颈丛穿刺相关结构的观测结果。胸膜顶的体表投影,胸膜顶的内侧界距胸骨柄上缘中点,左侧为14.2±0.3(11.0—19.0)mm,右侧为14.5±0.5(10.0—17.0)mm。胸膜顶的外侧界与胸锁关节之间的距离,左侧为55.3±0.6(43.0—70.0)mm,右侧为57.5±0.7(51.5—80.0)mm。胸膜顶的最凸点与锁骨之间的距离,左侧为21.6±0.4(11.0—29.0)mm,右侧为26.5±0.5(11.0—39.0)mm。肺尖与颈正中线的距离,左侧为38.4±0.6(31.0—52.0)mm,右侧为38.3±0.9(31.0—50.0)mm。星状神经节多居于第7颈椎横突基部与第1肋颈之间的前方。结论:为颈丛神经阻滞入路进针深度和预防并发症的发生提供了解剖学依据。

Objective： To provide anatomical basis for the blocking of cervical plexus, and prevention of its complication. Method＇The structures of neck and cervical plexus blocking and their neighboring relationships were observed by dissecting in 50 side of 25 adult corpses. Result： The distance from the skin （cross-point of the line between Cricoid＇s cartilage and the ditch of two pieces of scalenus and the posterior edge of steruocleidomastoid） to No.4 cervical vertebrae transverse process,was 21.0±0.4 （18.0-24.0）mm at the left side and 20.5±0.5（19.0-23.5） mm at the right side. The distance of the medial edge of cupula of pleura to the central point of superior edge of sternal manubrium, was 14.2±0.3（11.0-19.0）mm at the left side and 14.5±0.5（10.0-17.0）mm at the right side. The distance between the lateral side of cupula of pleura and steruoclavicular joint, was 55.3±0.6（43.0-70.0）mm at the left side, 57.5±0.7 （51.5-80.0）mm at the right side. The distance between the protruding apex of cupula of pleura and clavicle was 21.6±0.4 （11.0-29.0）mm at the left side, 26.5±0.5 （11.0-39.0）mm at the right side. The distance between the apex of lung and central line of neck was 38.4±0.6 （31.0-52.0）mm at the left side, 38.3±0.9（31.0- 50.0）mm at the right side. The stellate ganglion lay anterior to the space between the base of transverse process of the seventh cervical vertebra and the neck of the first rib. Conclusion：This study provide reference data for the depth of needle and anatomical basis for the prevention of complications caused by the blocking of the cervical plexus.