脊神经后支形态特点及其阻滞麻醉下腰椎间盘手术4063例报告

Anatomy of the posterior rami and its blocking anesthesia in lumbar discectomy with a 4063 cases report

目的 :介绍一种安全、简便、有效的腰椎间盘手术的局麻方法—脊神经后支阻滞法。方法 :0 .5 %普鲁卡因 10 0ml和 2 %利多卡因 2 0ml混合备用。先在切口处皮内注射 5ml麻药 ,再于开窗侧阻滞 5根脊神经后支主干 (上 3下 2 ) ,麻药用量 3～ 5ml。脊神经后支主干位于横突根部上缘。其体表投影点的确定方法是通过上下棘突连线的上中 1 3交界点作一水平线 ,该线是横突的上缘线的体表投影 ;旁开腰 1棘突 2cm取一点 ;再旁开腰 5棘突 3cm取一点 ;通过这两点作一直线 ,该线与各横线的交点即为各脊神经后支主干部的发出点。结果 :40 63例麻醉效果 :优 72 .2 % ,良 2 4.6% ,中 3 % ,差 0 .2 %。效果差者 ,经静脉使用镇痛镇静类药也取得较好效果。结论 :腰椎间盘手术采用脊神经后支阻滞麻醉经济安全可靠。

Objective: To introduce a kind of local anesthesia--spinal posterior rami blocking, for lumbar dicectomy.Methods: 0.5% procaine 100ml and 2% lidocaine 20 ml were mixed for use. 5 ml anaesthetic was injected hypodermic along the skin incision line, and then, five posterior rami (three over, two below) were blocked with 3～5 ml anaesthetic.The stem part of posterior ramus located at the upper edge of the basis of transverse processus.Its projection point on the skin can be located as follows: to make transverse lines between two processus, which cut superior one third of the length; to make a longitudinal line 2 cm lateral from L 1 processus and 3 cm lateral from L 5 processus;the cross points of the two lines were the projecting points of the stem of posterior rami.Results: A total of 4063 cases which underwent this method were reviewed.The effects were divided into 4 categories: excellent 72.2%, good 24.6%, medium 3%, and bad 0.2%. As for the 10 patients with bad effects, antalgic and ataractic were used intravenous, and satisfying results were got.Conclusion: The posterior rami blocking anesthesia for lumbar disc surgery is economical, safe and reliable.