针刺手三里穴位动态超声显像

Dynamic ultrasound imaging of the acupuncture on the Shousanli points

目的动态观察手三里穴位在针刺条件下的超声影像学解剖特征。方法选取健康志愿者15名,采用高频超声观察针灸针刺入受试者双侧手臂手三里穴后针尖的位置,以及针刺过程中与得气相关的解剖学结构。结果针刺15名受试者双侧手三里穴共30个穴位点均得气,针尖位置:桡侧腕伸肌13个,桡侧腕伸肌与旋后肌间筋膜9个,旋后肌浅层2个,旋后肌内筋膜4个,旋后肌深层1个,桡骨表面1个。28个(28/30,93.33%)针尖位于筋膜旁及筋膜集中处获得较强得气感、2个(2/30,6.67%)针尖位于较浅层即可获得较强得气感。高频超声可以清楚显示针尖点附近筋膜内的细小神经,二维声像图表现:桡神经深支沿着筋膜发出许多细小的分支,横断面声像图上呈筛孔样、回声较周围筋膜组织稍低。结论高频超声可以实时、动态、清楚地显示针刺点附近筋膜及筋膜内的细小神经分布,并可对针灸位置进行定量测定。

Objective To observe the anatomical characteristics of the Shousanli points in acupuncture by high-frequency ultrasound. Methods Fifteen participants received needling at two Shousanli points, high-frequency ultrasound was used to observe the position of needle tips when acupuncturing the Shousanli points, and the anatomical structures corresponding with ＂deqi＂ during acupuncture in 30 cases. Results All of the 15 volunteers with 30 Shousanli points got ＂deqi＂, the nee- dle tips position： 13 in The extensor carpi radialis muscle, 9 in the fascia between extensor carpi radialis muscle and supina- tion muscle, 2 in the shallow supinator muscle, 4 in the fascia between the shallow and the deep supinator muscle, 1 in the deep supinator muscle, 1 in the surface of radius. There were 28 （28/30, 93.33%） mainly in near fascia or where fascia concentrated when volunteers presented strong ＂deqi＂, and 2 （2/30, 6.67%） were in superficial structure when volunteers presented strong ＂deqi＂. High-frequency ultrasound can provide clear observation of the very small nerve distribution in fascia around the needle points in acupuncture. The ultrasound image showed many small branches of the deep branch of ra- dial nerve along the fascia, and the image of the small nerve on cross section was in mesh sample and the echo was slightly lower than fascia tissue around it. Conclusion High-frequency ultrasound can provide real-time, dynamic and accurate ob- servation of the fascia and the very small nerve distribution in fascia around the needle points in acupuncture, as well as quantitative measurement of the tip position.