X线透视下以胫骨外侧髁间隆起为骨性标志行腘静脉穿刺

The research of percutaneous popliteal vein puncture under roentgenoscopy and marked by the lateral intercondylar eminence

目的:研究X线透视下以胫骨外侧髁间隆起为骨性标志经皮腘静脉穿刺的方法。方法:对41例(44支)顺行性下肢静脉造影片进行分析,测量每支腘静脉的中轴线与胫骨外侧髁间隆起尖部投影图像的垂直距离,统计计算中位数,设计出在X线透视下以胫骨外侧髁间隆起为骨性标志的穿刺进针点和穿刺方法,并在28例下肢深静脉血栓形成患者的治疗过程中进行初步验证。结果:44支腘静脉中,中轴线与胫骨外侧髁间隆起尖部投影图像的垂直距离,最大为12mm,最小-5mm(即内侧5mm),中位数2.75mm,此即腘静脉的中心值。取胫骨外侧髁间隆起尖部旁开3mm(取2.75mm之整数)处进针,可兼顾腘静脉内外不同位置的穿刺。本组28例下肢深静脉血栓形成者,以此方法穿刺腘静脉,初步证实成功率100%。结论:该方法方便、快捷、经济、实用,值得进一步推广应用。

Objective：To research and conduct percutaneous popliteal vein puncture under rocntgenoscopy, with the lateral intercondylar eminence of tibia as the bony mark.Methods： By analyzing the imaging features of 41 eases （44 extremities） of ascending venngrapby of lower limbs, and calculating the vertical distance between the axis of each popliteal vein and the imaging of the apex of the lateral intercondylar eminence, the median was worked out. Then by referring to related literature, the optimizing puncture point and the way to conduct puncture under rocntgenoscopy were researched, with lateral intercondylar eminence as the bony mark. This method was then experimented in the treatment of 28 cases of lower extremity deep venous thrombosis. Results： Of the 44 popliteal veins, the maximum vertical distance between the axis and the imaging of the apex of the lateral intercondylar eminence was 12 mm, the minimum was - 5 mm, and the median was 2.75 mm, which was the central point of the popliteal vein. So the puncture point can be thus located at 3 mm to the apex of the lateral intercondylar eminence, which catheters to popliteal vein puncture at different locations. With fan-shaped puncture, insert the needle at the outside point rather than the inside point, and try to avoid the risk of puncturing the anterior wall of this vein, then the possibility of improper popliteal artery puncture would be reduced or even prevented beforehand. To treat the 28 cases of lower extremity deep venous thrombosis by popliteal vein puncture, the success ratio at present turned out to be 100%. Conclusion：The method introduced above is convenient, economical and practical, thus application on a larger-scale is recommended.