超声辅助定位胸椎水平的准确性及影响因素分析

Analysis of the accuracy and influencing factors of ultrasound-assisted localization of thoracic vertebral level

目的探讨超声辅助定位法定位胸椎水平的准确性,并与体表标志触诊法进行比较。方法选择我院择期行脊柱手术的患者48例,术前由一名熟练掌握触诊定位的麻醉医师通过体表标志触诊法定位第7颈椎(C7)棘突后,向尾侧依次触诊直至确定第7胸椎(T7)棘突位置并标记为T7a。然后由另一名熟练掌握脊柱超声的麻醉医师使用低频凸阵探头放置于颈椎水平横切面上下扫查,确定C7棘突后继续向尾侧扫查确定T1棘突和横突位置并标记,再依次扫查确定T7横突位置并标记为T7b。最后由同一脊柱外科医师通过C臂机拍摄图像确定T7的准确位置,以判定T7a和T7b的定位是否正确。探讨体质量指数(BMI)和年龄对两种定位方法准确性的影响。结果超声辅助定位法准确率为85.4%,显著高于体表标志触诊法(52.1%),差异有统计学意义(P<0.05);超声辅助定位法相较于体表标志触诊法降低了个体差异对定位的影响;BMI和年龄对两种定位方法准确率的影响比较差异均无统计学意义。结论超声辅助定位法优于体表标志触诊法,有重要的临床应用价值。

Objective To compare and explore the accuracy of ultrasound-assisted positioning of the thoracic vertebral body level with palpation positioning method.Methods A total of 48 patients underwent elective spinal surgery were selected,including 19 males and 29 females.The ASA classification wasⅠ~Ⅲ.After spinous process of C7 was identified with palpation by a skilled anesthesiologist,palpation was performed to the tail side until spinous process of T7 was identified and marked with T7a.Then,a low-frequency convex array probe was used to determine the T7 transverse process position performed by an anesthesiologist skilled in spinal ultrasound,and marked with T7b.Finally,a C-arm X ray machine was used to confirm the exact position of T7 and to determine whether the positioning of T7a or T7b was accurate.The influence of BMI and age to the accuracy of the two positioning methods was analyzed.Results The accuracy rate of ultrasound-assisted positioning method was 85.4%,which was significantly higher than that of body surface mark palpation method(52.1%),and the difference was statistically significant(P<0.05).Compared with the palpation method,the ultrasound-assisted positioning method reduced the influence of individual differences on the positioning.The influence of BMI and age to the accuracy of the two positioning methods was not statistically significant.Conclusion Ultrasound-assisted positioning method is better than body surface mark palpation method,which has important clinical value.