超声引导上臂选择性神经阻滞对肘关节运动的影响

The effect of ultrasound-guided selective upper arm nerve block on motor function of elbow joint

目的探索超声引导下上臂选择性神经阻滞对肘关节运动功能的影响.方法对25例健康志愿者行超声引导下上臂选择性神经扫描,追踪桡神经与肌皮神经走行.在此基础上,选择20例择期行手、腕部及前臂手术的患者,年龄≥18岁,ASA分级Ⅰ~Ⅲ级,行超声引导下上臂选择性神经阻滞,使用频率为6~15 MHz线阵探头,5 cm神经阻滞针在超声引导下注射0.375%罗哌卡因25 ml.结果在上臂中上1/3交界处,正中神经有68%在肱动脉的12点钟与1点钟之间,尺神经与前臂内侧皮神经有56%处于贵要静脉的3点钟附近位置.在上臂中点附近,桡神经有94%已经发出超声可见的分支,肌皮神经100%已经发出超声可见的分支.在上臂中下1/3交界处,超声影像中支配肘以下的桡神经分支位于肱肌与肱骨之间,靠近外侧;支配前臂外侧的肌皮神经分支位于肱二头肌与肱肌之间,靠近内侧.桡神经有80%处于9点钟与12点钟之间的位置,肌皮神经有84%处于3点钟与12点钟之间的位置.20例患者中,有1例肘关节伸肘功能减弱,恢复时间为120 min;肩关节运动功能未受到阻滞;阻滞起效时间:肌皮神经(5.2±1.3)min,桡神经(6.2±1.5)min,尺神经(8.4±1.7)min,前臂内侧皮神经(8.2±1.7)min,正中神经(10.4±1.9)min;感觉功能恢复时间540(540,600)min.结论超声引导的上臂选择性神经阻滞能保证手术需求的同时,最大限度保留肘关节运动功能.

Objective To explore the effect of ultrasound-guided selective upper arm nerve block on motor function of elbow joint.Methods Ultrasound-guided selective upper arm nerve scanning was performed on 25 healthy volunteers to track the course of the radial and musculocutaneous nerves.On this basis,20 patients who underwent elective hand,wrist,and forearm surgery,aged≥18 years,with ASA grades Ⅰ to Ⅲ,were selected to undergo ultrasound-guided selective upper arm nerve block using a 6 to 15 MHz linear array probe and a 5 cm nerve block needle.25 ml of 0.375% ropivacaine was injected under ultrasound-guided guidance.Results At the junction of the upper one-third of the upper arm,68% of the median nerve was located between 12 o'clock and 1 o'clock in the brachial artery,and 56% of the ulnar nerve and medial forearm cutaneous nerve were located near 3 o'clock in the basilic vein.Near the midpoint of the upper arm,94%of the radial nerve had branches visible on ultrasound,and 100% of the musculocutaneous nerve had branches visible on ultrasound.At the junction of the middle and lower one-third of the upper arm,the radial nerve branch innervated below the elbow in ultrasound images was located between the brachial muscle and the humerus,near the lateral side.The musculocutaneous nerve branch that innervates the lateral forearm was located between the biceps and brachialis muscles,near the medial side.80% of the radial nerve was located between 9 o'clock and 12 o'clock,and 84% of the musculocutaneous nerve was located between 3 o'clock and 12 o'clock.Among the 20 patients,one had weakened elbow joint extension function,with a recovery time of 120 minutes.The shoulder joint movement function was not blocked.The blockage onset time was(5.2±1.3)minutes for musculocutaneous nerve,(6.2±1.5)minutes for radial nerve,(8.4±1.7)minutes for ulnar nerve,(8.2±1.7)minutes for medial forearm cutaneous nerve,(10.4±1.9)minutes for median nerve.The recovery time of sensory function was 540(540,600)minutes.Conclusion Ultrasound-guided selective upper arm nerve block can ensure surgical requirements while maximizing the preservation of elbow joint motor function.