股神经阻滞相关筋膜层次解剖:薄层塑化与超声影像对比

Anatomy of the fascia associated with femoral nerve block:a comparison of sheet plastination and ultrasound images

目的揭示股神经阻滞操作区域股神经前方筋膜的层次结构,为临床超声下股神经阻滞定位提供准确的解剖学依据。方法选取3具成人盆部标本,制作横断面连续薄层塑化切片观察并分析;临床收集36例股神经阻滞操作超声影像,结合薄层塑化图像进行对比分析。结果薄层塑化结果显示,在股神经阻滞操作对应层面,髂筋膜紧密覆盖于股神经与髂腰肌表面,在内侧延续为股鞘后外侧壁,未见髂筋膜形成包绕股神经的筋膜鞘样结构。阔筋膜自缝匠肌表面向内走行至股鞘前方,覆盖髂筋膜、股神经、髂腰肌、股鞘等结构;3例(6侧)标本中,4侧显示阔筋膜在缝匠肌内侧缘未融合而分为两层,2侧显示在缝匠肌前缘融合为单层。超声图像显示股神经前方筋膜均可视,髂筋膜为白色条索状高回声影,位于股神经前方且与股神经紧密相邻;阔筋膜覆盖股神经、髂筋膜、股鞘,与股神经相距较远;36例超声影像中,30例显示阔筋膜为两层,6例显示为1层。结论髂筋膜与股神经关系紧密,可作为超声引导的股神经阻滞的定位标志,分层的阔筋膜易被误认为髂筋膜,应根据其移行特点进行准确地辨识。

Objective To reveal the fascial configuration in front of the femoral nerve and to identify accurate anatomical landmarks for the ultrasound-guided femoral nerve block. Methods Three adult pelvices tissues were transversely sectioned for epoxy sheet plastination. Ultrasound-guided femoral nerve block images were collected from 36 patients to compare the result of the plastination study. Results Plastinated slices displayed that the fascia lata was extended from sartorius muscle laterally to the front wall of femoral sheath medially. The fascia lata covered iliac fascia,femoral nerve,iliopsoas and femoral sheath. In four out of six sides,the double layers of fascia lata did not unite in the medial border of the sartorius muscle,but in the remaining two sides,they merged into a single layer in the front of the sartorius muscle. The iliac fascia tightly covered femoral nerve and iliopsoas. Medially,it passed the posterior-lateral femoral sheath and then became the pectineal ligament. The iliac fascia did not form the fascia sheath-like structure to wrap the femoral nerve. The fascia in front of femoral nerve was clearly displayed under ultrasound. In 30 out of 36 cases,the fascia lata had two layers and other six cases showed that the fascia lata had one layer. Conclusion The iliac fascia is closely related to the femoral nerve. It can be used as an ideal anatomical landmark for ultrasound-guided femoral nerve block. The fascia lata may likely be misidentified as the iliac fascia.