体位对老年患者腰椎间隙黄韧带长度超声测值的影响

Effect of Position on Ultrasonographic Measurement of Ligamentum Flavum Length of Lumbar Intervertebral Space in the Elderly Patients

目的探讨体位对老年患者腰椎间隙黄韧带长度超声测值的影响。方法选择年龄超过65岁拟行腰椎管内阻滞的老年患者40例,以旁正中矢状斜切面超声扫查坐位与左侧卧位下腰3/4、腰4/5、腰5/骶1椎间隙。测量并记录各间隙黄韧带前缘长度(anterior edge length of the ligamentum flavum,ALL)及皮肤至黄韧带前缘距离(distance from skin to the ligamentum flavum,DSL);评估并记录图像清晰度。结果与左侧卧位测值比较,坐位下腰5/骶1 ALL长,且长于坐位腰3/4值(P<0.05);与腰3/4测值比较,坐位下腰5/骶1 DSL值浅(P<0.05)。与腰5/骶1声图像比较,坐位与左侧卧位下腰3/4、4/5间隙左右两侧清晰度良好率较低(P<0.05)。结论老年患者坐位下腰5/骶1 ALL超声测值长于左侧卧位相应值,也长于同一体位下腰3/4、腰4/5值,且其深度及声图像较其它间隙浅而清晰;建议此类患者采用旁正中穿刺入路行椎管内阻滞时,坐位下选择相对浅宽的腰5/骶1,左右两侧相当,尤其超声引导下。

Objective To investigate effect of body position on ultrasonographic measurement of ligamentum flavum lengthin lumbar intervertebral space in the elderly patients.Methods 40 patients over 65 years of age who underwent spinal anesthesia were selected to examine the L 3/4,L 4/5 and L 5/S1 intervertebral spaces.Anterioredge length oftheligamentum flavum(ALL)and distance from skin to theligamentum flavum(DSL)of L3/4,L4/5 and L5/S1 intervertebral spaces were measured by ultrasonic parasagittal oblique view in both sitting and left lateral decubitus position,and definition degree of each ultrasonic image were analyzed.Results Compared with the measurement in left lateral position,ALL at L5/S1 level in sitting position was longer,and longer than that at L3/4 in the same position(P<0.05);DSL at L5/S1 was lower than that at L3/4 in sitting position(P<0.05).Compared with ultrasonic definition of L5/S1,the fine definition rate of the left and right sides of L3/4 and L4/5 in both positions was lower(P<0.05).Conclusion The ALL ultrasonic measurement at L5/S1 level in sitting position was longer than that in left lateral decubitus position,and also longer than that at L3/4 and L4/5 in the same position,its depth and image were shallower and clearer than other spaces.It is recommended for elderly patients to use the paramidian puncture approach for lumbar anesthesia.The relatively shallow width of L5/S1 should be selected under the sitting position,and the left and right sides are equivalent,especially under the guidance of ultrasound.