经胸锁乳突肌外侧缘颈内静脉穿刺置管的解剖学基础研究

Anatomy Via the Lateral Border of the Sternocleidomastoid by Internal Jugular Vvein Catheterization

目的为经胸锁乳突肌(SCM)外侧缘行颈内静脉(IJV)穿刺置管提供解剖学基础。方法观测15具成年尸体右侧IJV及其周围组织的解剖学结构。结果 (1)不同头位下:头处于正中位0°时,在甲状软骨上缘(SBTC)解剖平面IJV位于颈总动脉(CCA)后外侧方的13具(86.6%),位于CCA外侧方2具(13.4%);在环状软骨(CC)、第七颈椎(C7)、胸锁关节解剖平面,所有尸体的IJV均位于CCA的外侧,并与CCA紧密伴行;头向左偏转至30°时,四个解剖平面的IJV呈向CCA外侧前方逐渐偏移的趋势,但均位于CCA的外侧;与0°头位比较,IJV中点至CCA中点的距离,在SBTC解剖平面和CC、C7、胸锁关节解剖平面均无统计学差异(P均>0.05),IJV外侧缘至SCM外侧缘皮肤的距离,在SBTC、CC、C7解剖平面呈明显缩短的趋势(P<0.01),在胸锁关节解剖平无统计学差异(P>0.05)。(2)同一头位下:自SBTC至胸锁关节解剖平面,IJV中点至CCA中点的距离逐渐增加,而IJV外侧缘至SCM外侧缘皮肤的距离呈逐渐缩短的趋势,但CC、C7、胸锁关节解剖平面较SBTC解剖平面,IJV中点至CCA中点的距离明显增宽(P<0.01),而IJV外侧缘至SCM外侧缘皮肤的距离明显缩短(P<0.01)。结论较为理想的进针部位应在CC解剖平面与SCM外侧缘交点附近,头向左偏转30°,右侧颈内静脉进针方向应与躯体冠状面平行,针尖指向对侧胸锁关节。

Objective To provide anatomical basis for the lateral border of the sternocleidomastoid( SCM) by internal jugular vein catheterization( IJV). Methods The right IJV and correlative structures were observed and measured on 15 adult cadaveric specimens. Results( 1) At the different head position: when the head at the middle position,at the level of the superior border of the thyroid cartilage( SBTC),the position of the IJV was situated in the behind- lateral to the common carotid artery( CCA) in 13 samples( 86. 6%),2 were situated in the lateral position( 13. 4%); at the level of the cricoid cartilage( CC),the seventh cervical vertebra( C7) and the sternoclavicular joint,the IJV were situated in lateral to the CCA in all the samples; When the head turned to the left at 30°,at the four anotomic levels the relationship of the IJV and the CCA were gradually turned to outer- anterior; At the head rotation of 30° compared to 0°,the distance from the midpoint of the IJV and the midpoint of the CCA,at the level of the SBTC was increased,while at the level of the CC,C7 and the sternoclavicular joint were gradually shorter,but there were no statistical significance( P > 0. 05),the distance from the lateral border of the IJV to the skin of the lateral border of the SCM,at the level of the SBTC,CC and C7 were significant shorter( P < 0. 01),at the level of the sternoclavicular joint was shorter,but there was no statistical significance( P > 0. 05).( 2) At the same head position: from the level of the SBTC to the level of the sternoclavicular joint,the distance from the midpoint of the IJV and the midpoint of the CCA were gradually increased,while the distances from the lateral border of the IJV to the skin of the lateral border of the SCM were gradually shorter,but the levels of the CC,the C7 and the sternoclavicular joint compared to the level of the SBTC,the distance from the midpoint of the IJV and the midpoint of the CCA was significant increased( P < 0. 01),while the distance from the lateral border of the IJV to the skin of the lateral border of the SCM was significant shorter( P < 0. 01). Conclusion The optimal access for the IJV catheterization by the lateral border of the SCM was the head turned to the left 30°,at the cross point of the CC and the lateral border of the SCM,the direction was paralleled to the coronal plane,pointed to the contralateral sternoclavicular joint.