颈段硬膜外腔侧隐窝穿刺置管进路的研究和应用

Study on approach to lateral recess of cervical epidural space for epidural catheterization

目的 研究能将药物更直接集中注射到颈段硬膜囊前间隙或/和侧隐窝的穿刺置管进路。方法 颈椎钩状突外缘与关节柱内缘重叠巨均与小关节内缘在同一矢状面上,因此测量钩状突外缘间距便可得知小关节内缘间距,我们测量结果为23～25mm（C5-6-7水平）,平均 24mm;选择病变间隙的下1～2个间隙的下位棘突为穿刺水平。旁开距离为测得的该小关节内缘间距除以2,再减去2mm。用16G硬膜外穿刺针,经进针点垂直皮面进针,直到左侧椎板,稍退针2mm,改朝头端45～60度角进针,使穿刺针勺状面背侧紧贴左侧椎板及其上缘滑入小关节内缘,遇到韧性阻力为黄韧带,一旦阻力消失,有落空感,为突破黄韧带进入侧隐窝。选择45例颈椎间盘突出症病人,利用该进路进行溶盘治疗。其中10例病人经造影观察了导管的位置和造影剂的分布。结果45例病人治疗效果满意。10例造影病人,造影剂均集中分布在患侧侧隐窝或/和硬膜囊前间隙。结论 经颈椎小关节内缘穿刺置管可将药物集中注入硬膜外腔侧隐窝或俐硬膜囊前间隙,更好地发挥治疗作用,减少不良反应。

The distance between the medial border of the two articular processes was measured by CT and MRI. At the level of C5-6-7 it was 23-25 mm(24mm on average). If the distance is 24 mm at C5-6 a tuohy needle is inserted 10 mm(24÷2-2) lateral to the midline. When the needle touches vertebral lamina, withdraw the needle 2mm and redirect it cephalad at 45-60, Resistance is encountered when the needle touches ligament flavum. When the resistance disappears, the tip of the needle has entered the lateral recess via tuohy needle. This approach was used in 45 patients with satisfactory results. In ten patients the position of the cathter was confirmed with contrast medium by CT and MRI.