Mechanical properties of nerve roots and rami radiculares isolated from fresh pig spinal cords

No reports have described experiments designed to determine the strength characteristics of spinal nerve roots and rami radiculares for the purpose of explaining the complexity of symptoms of medullary cone lesions and cauda equina syndrome. In this study, to explain the pathogenesis of cauda equina syndrome, monoaxial tensile tests were performed to determine the strength characteristics of spinal nerve roots and rami radiculares, and analysis was conducted to evaluate the stress-strain relationship and strength characteristics. Using the same tensile test device, the nerve root and ramus radiculares isolated from the spinal cords of pigs were subjected to the tensile test and stress relaxation test at load strain rates of 0.1, 1, 10, and 100 s-1 under identical settings. The tensile strength of the nerve root was not rate dependent, while the ramus radiculares tensile strength tended to decrease as the strain rate increased. These findings provide important insights into cauda equina symptoms, radiculopathy, and clinical symptoms of the medullary cone.

Pulsed electrical stimulation protects neurons in the dorsal root and anterior horn of the spinal cord after peripheral nerve injury

Most studies on peripheral nerve injury have focused on repair at the site of injury, but very few have examined the effects of repair strategies on the more proximal neuronal cell bodies. In this study, an approximately 10-mm-long nerve segment from the ischial tuberosity in the rat was transected and its proximal and distal ends were inverted and sutured. The spinal cord was subjected to pulsed electrical stimulation at T10 and L3, at a current of 6.5 m A and a stimulation frequency of 15 Hz, 15 minutes per session, twice a day for 56 days. After pulsed electrical stimulation, the number of neurons in the dorsal root ganglion and anterior horn was increased in rats with sciatic nerve injury. The number of myelinated nerve fibers was increased in the sciatic nerve. The ultrastructure of neurons in the dorsal root ganglion and spinal cord was noticeably improved. Conduction velocity of the sciatic nerve was also increased. These results show that pulsed electrical stimulation protects sensory neurons in the dorsal root ganglia as well as motor neurons in the anterior horn of the spinal cord after peripheral nerve injury, and that it promotes the regeneration of peripheral nerve fibers.

Effects of intrathecal injection of glial cell inhibitor on spinal cord astrocytes following chronic compression of dorsal root ganglia in rats

BACKGROUND： Astrocytes are considered to provide nutritional support in the central nervous system. However, recent studies have confirmed that astrocytes also play an important role in chronic pain. OBJECTIVE： To investigate the effects of intrathecal injection of fluorocitrate, minocycline or both on astrocyte activation and proliferation in the spinal dorsal horn of compressed dorsal root ganglion in rats. DESIGN, TIME AND SETTING： The neurology randomized controlled animal study was performed at the Jiangsu Institute of Anesthesia Medicine, from September 2006 to April 2007. MATERIALS： A total of 96 male Sprague Dawley rats, aged 6-8 weeks, were selected for this study. Following intrathecal catheterization, 80 rats underwent steel bar insertion into the L4-5 intervertebral foramina to make a stable compression on the L4-5 posterior root ganglion. Thus rat models of ganglion compression were established. Minocycline and fluorocitrate were purchased from Sigma, USA. METHODS： A total of 96 rats were randomly and equally divided into six groups. Rat L4, L5 transverse process and intervertebral foramina were exposed in the sham operation group, but without steel bar insertion. The model group did not receive any manipulations. Rats in the phosphate buffered saline （PBS） group were intrathecally injected with 0.01 mmol/L PBS （20 μL）. Rats in the fluorocitrate group were subjected to 1 μmol/L fluorocitrate （20 μL）. Rats in the minocycline group were intrathecally injected with 5 g/L minocycline （20 μL）. Rats in the minocycline and fluorocitrate group received a mixture （20 μL） of 5 g/L minocycline and 1 μmol/L fluorocitrate. Following model establishment, drugs were administered once a day. MAIN OUTCOME MEASURES： At 7 and 14 days following model induction, glial fibrillary acidic protein expression in the spinal dorsal horn was measured by immunofluorescence microscopy. Six sections with significant glial fibrillary acidic protein -positive expression were obtained to count astrocytes under an inverted microscope. RESULTS： No significant differences in astrocyte count were detected between the fluorocitrate and model groups. Cell bodies were small with a few processes in the fluorocitrate group, compared with the model group. The astrocyte count decreased significantly in the minocycline group and the minocycline and fluorocitrate group compared with the sham operation, model, PBS and fluorocitrate groups （P 〈 0.01）. The decrease in astrocyte count was mainly found in layers Ⅲ–Ⅳ of the spinal dorsal horn. Cell body volume was smaller and process numbers were fewer in the minocycline group and the minocycline and fluorocitrate group, compared with the model and PBS groups. CONCLUSION： Fluorocitrate can inhibit astrocyte activation, but does not affect astrocyte proliferation. However, minocycline can inhibit the activation and proliferation of astrocytes.

Combined Sacral Nerve Roots Stimulation and Low Thoracic Spinal Cord Stimulation for the Treatment of Chronic Pelvic Pain

Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency [1]-[3], can be successfully used for the treatment of chronic pelvic pain [4]-[7]. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain [8] and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain [9]. We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.

Effect of continuous spinal anesthesia with ropivacaine on the ultrastructure of spinal cord and nerve roots in rats

To investigate the effects of continuous spinal anesthesia with different concentrations and doses of ropivacaine on the ultrastructure of the spinal cord and nerve roots.Methods Twenty-four male SD rats weighing 220～280 g were anesthetized with intraperitoneal 10% chloral hydrate 300～350 mg/kg.A polyurethane microcatheter was inserted into the lumbar subarachnoid space according to the technique described by Yaksh.An 8 cm catheter segment was left in the subarachnoid space.The animals were randomized to receive normal saline,0.5%,0.75% or 1.0% ropivacaine 40 μl intrathecally 3 times at 1.5 h interval.Six hours after the first intrathecal administration the animals were decaptiated and L 1,2 segment of the spinal cord and nerve roots were immediately removed for electron microscopic examination.Results Electron microscopic examination revealed that in animals which received intrathecal (i.t.) normal saline,0.5% or 0.75% ropivacaine the neurolemma of the nerve roots and the mitochondria and endoplasmic reticulum of the neurons in the spinal cord were intact,while in animals which received i.t. 10.% ropivacaine the neurolemma was stratified and partly disrupted and there were swelling of endoplasmic reticulum and vacuole degeneration.Conclusion Six hours continuous spinal anesthesia with 10.% ropivacaine may be injurious to the spinal cord and nerve roots.12 refs,8 figs,1 tab.

Peripheral nerve injury induced changes in the spinal cord and strategies to counteract/enhance the changes to promote nerve regeneration

Peripheral nerve injury leads to morphological, molecular and gene expression changes in the spinal cord and dorsal root ganglia, some of which have positive impact on the survival of neurons and nerve regeneration, while the effect of others is the opposite. It is crucial to take prompt measures to capitalize on the positive effects of these reactions and counteract the negative impact after peripheral nerve injury at the level of spinal cord, especially for peripheral nerve injuries that are severe, located close to the cell body, involve long distance for axons to regrow and happen in immature individuals. Early nerve repair, exogenous supply of neurotrophic factors and Schwann cells can sustain the regeneration inductive environment and enhance the positive changes in neurons. Administration of neurotrophic factors, acetyl-L-carnitine, N-acetyl-cysteine, and N-methyl-D-aspartate receptor antagonist MK-801 can help counteract axotomy-induced neuronal loss and promote regeneration, which are all time-dependent. Sustaining and reactivation of Schwann cells after denervation provides another effective strategy. FK506 can be used to accelerate axonal regeneration of neurons, especially after chronic axotomy. Exploring the axotomy-induced changes after peripheral nerve injury and applying protective and promotional measures in the spinal cord which help to retain a positive functional status for neuron cell bodies will inevitably benefit regeneration of the peripheral nerve and improve functional outcomes.

A novel mouse model of central cord syndrome

Patients with potential spinal stenosis are susceptible to central cord syndrome induced by blunt trauma.Suitable animal models are helpful for studying the pathogenesis and treatment of such injuries.In this study,we established a mouse model of acute blunt traumatic spinal cord injury by compressing the C6 spinal cord with 5 and 10 g/mm~2 compression weights to simulate cervical central cord syndrome.Behavioral testing confirmed that this model exhibited the characteristics of central cord syndrome because motor function in the front paws was impaired,whereas basic motor and sensory functions of the lower extremities were retained.Hematoxylin-eosin staining showed that the diseased region of the spinal cord in this mouse model was restricted to the gray matter of the central cord,whereas the white matter was rarely affected.Magnetic resonance imaging showed a hypointense signal in the lesion after mild and severe injury.In addition,immunofluorescence staining showed that the degree of nerve tract injury in the spinal cord white matter was mild,and that there was a chronic inflammation reaction.These findings suggest that this mouse model of central cord syndrome can be used as a model for preclinical research,and that gray matter is most vulnerable to injury in central cord syndrome,leading to impaired motor function.

A progressive compression model of thoracic spinal cord injury in mice： function assessment and pathological changes in spinal cord

Non-traumatic injury accounts for approximately half of clinical spinal cord injury, including chronic spinal cord compression. However, previous rodent spinal cord compression models are mainly designed for rats, few are available for mice. Our aim is to develop a thoracic progressive compression mice model of spinal cord injury. In this study, adult wild-type C57BL/6 mice were divided into two groups： in the surgery group, a screw was inserted at T9 lamina to compress the spinal cord, and the compression was increased by turning it further into the canal（0.2 mm） post-surgery every 2 weeks up to 8 weeks. In the control group, a hole was drilled into the lamina without inserting a screw. The results showed that Basso Mouse Scale scores were lower and gait worsened. In addition, the degree of hindlimb dysfunction in mice was consistent with the degree of spinal cord compression. The number of motor neurons in the anterior horn of the spinal cord was reduced in all groups of mice, whereas astrocytes and microglia were gradually activated and proliferated. In conclusion, this progressive compression of thoracic spinal cord injury in mice is a preferable model for chronic progressive spinal cord compression injury.

Scanning pattern of diffusion tensor tractography and an analysis of the morphology and function of spinal nerve roots

Radiculopathy, commonly induced by intervertebral disk bulging or protrusion, is presently diag- nosed in accordance with clinical symptoms because there is no objective quantitative diagnostic criterion. Diffusion tensor magnetic resonance imaging and diffusion tensor tractography revealed the characterization of anisotropic diffusion and displayed the anatomic form of nerve root fibers. This study included 18 cases with intervertebral disc degeneration-induced unilateral radiculopathy. Magnetic resonance diffusion tensor imaging was creatively used to reveal the scanning pattern of fiber tracking of the spinal nerve root. A scoring system of nerve root morphology was used to quantitatively assess nerve root morphology and functional alteration after intervertebral disc de- generation. Results showed that after fiber tracking, compared with unaffected nerve root, fiber bundles gathered together and interrupted at the affected side. No significant alteration was de- tected in the number of fiber bundles, but the cross-sectional area of nerve root fibers was reduced. These results suggest that diffusion tensor magnetic resonance imaging-based tractography can be used to quantitatively evaluate nerve root function according to the area and morphology of fiber bundles of nerve roots.

Association between chromosomal aberration of COX8C and tethered spinal cord syndrome:array-based comparative genomic hybridization analysis

Copy number variations have been found in patients with neural tube abnormalities.In this study,we performed genome-wide screening using high-resolution array-based comparative genomic hybridization in three children with tethered spinal cord syndrome and two healthy parents.Of eight copy number variations,four were non-polymorphic.These non-polymorphic copy number variations were associated with Angelman and Prader-Willi syndromes,and microcephaly.Gene function enrichment analysis revealed that COX8 C,a gene associated with metabolic disorders of the nervous system,was located in the copy number variation region of Patient 1.Our results indicate that array-based comparative genomic hybridization can be used to diagnose tethered spinal cord syndrome.Our results may help determine the pathogenesis of tethered spinal cord syndrome and prevent occurrence of this disease.

Prolonged electrical stimulation causes no damage to sacral nerve roots in rabbits

Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re- mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9_10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu- lation. There was no significant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental findings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.

Tanshinone ⅡA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction

Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.

Senegenin inhibits neuronal apoptosis after spinal cord contusion injury

Senegenin has been shown to inhibit neuronal apoptosis,thereby exerting a neuroprotective effect.In the present study,we established a rat model of spinal cord contusion injury using the modified Allen＇s method.Three hours after injury,senegenin（30 mg/g） was injected into the tail vein for 3 consecutive days.Senegenin reduced the size of syringomyelic cavities,and it substantially reduced the number of apoptotic cells in the spinal cord.At the site of injury,Bax and Caspase-3 m RNA and protein levels were decreased by senegenin,while Bcl-2 m RNA and protein levels were increased.Nerve fiber density was increased in the spinal cord proximal to the brain,and hindlimb motor function and electrophysiological properties of rat hindlimb were improved.Taken together,our results suggest that senegenin exerts a neuroprotective effect by suppressing neuronal apoptosis at the site of spinal cord injury.

An atypical primary malignant melanoma arising from the cervical nerve root: A case report and review of literture

BACKGROUND Primary melanomas affecting the central nervous system are very rare,and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer.As a consequence,not much is known about this.CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root.A 64-year-old woman presented with symptoms of numbness in the right side of the neck,pain,and hypoesthesia in the right upper limb which persisted for 1 year.Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4.Magnetic resonance imaging examination revealed a mass(approximately 2.5 cm×1.4 cm×1 cm)in the right side of the spinal canal in the C-2 plane.Based on findings obtained during operation,perioperative examination,pathological diagnosis,and the diagnostic criteria of primary central melanoma proposed by Hayward,the mass was confirmed to be a melanoma of intraspinal nerve root origin.CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal.The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours.Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.

Distribution of paired immunoglobulin-like receptor B in the nervous system related to regeneration difficulties after unilateral lumbar spinal cord injury

Paired immunoglobulin-like receptor B（Pir B） is a functional receptor of myelin-associated inhibitors for axonal regeneration and synaptic plasticity in the central nervous system, and thus suppresses nerve regeneration. The regulatory effect of Pir B on injured nerves has received a lot of attention. To better understand nerve regeneration inability after spinal cord injury, this study aimed to investigate the distribution of Pir B（via immunofluorescence） in the central nervous system and peripheral nervous system 10 days after injury. Immunoreactivity for Pir B increased in the dorsal root ganglia, sciatic nerves, and spinal cord segments. In the dorsal root ganglia and sciatic nerves, Pir B was mainly distributed along neuronal and axonal membranes. Pir B was found to exhibit a diffuse, intricate distribution in the dorsal and ventral regions. Immunoreactivity for Pir B was enhanced in some cortical neurons located in the bilateral precentral gyri. Overall, the findings suggest a pattern of Pir B immunoreactivity in the nervous system after unilateral spinal transection injury, and also indicate that Pir B may suppress repair after injury.

Tumor Lysis Syndrome in the Course of Burkitt Lymphoma Revealed by Medullar Compression

Background: Tumor lysis syndrome is unknown to many neurosurgical teams. A dreaded complication, especially in the course of hematological malignancies, like it was the case in two of our patients operated for spinal cord compression by Burkitt’s lymphoma. Objectives: To describe the clinical and biological presentation of this potentially fatal complication, which can be improved by early preventive or curative treatments. Case Reports: Patient 1: A 49-year-old woman was admitted for vertebral and intercostal pain and paraparesis. Myelography revealed epidural medullary compression at the 7th thoracic vertebrae (Th7) level. Patient 2: A 67-year-old woman was admitted for cervico-thoracic pain and paraparesis. MRI showed posterior epidural medullary compression between the 1st thoracic vertebrae (Th1) and 5th thoracic vertebrae (Th5). In both cases, an urgent decompressive laminectomy was performed. They had also received postoperative corticosteroid therapy. The multi-visceral failure occurred on the 1st day (D1) and 3rd day (D3) postoperatively, respectively. In the absence of adequate management, the outcome was fatal for the two patients respectively at D3 and D5 postoperatively. This syndrome was retained in the presence of glucocorticoid (triggering factor) and the histological result in favor of Burkitt lymphoma (target disease). Conclusion: Malignant hemopathies is a common cause of spinal cord compressions. From these two cases, the importance of biological and clinical surveillance emerges, with patients requiring urgent management for radiculo-medullar tumor compression.

颈椎病动物模型及其内在分子机制

背景:将临床疾病完全转化为动物模型存在许多问题,但理想的动物模型是进行颈椎病机制研究的前提,因此选择合适的颈椎病动物模型至关重要。目的:详细分析颈椎病动物模型的物种、性别、年龄、颈椎病模型类型及其内在分子机制,探讨如何选择合适的动物模型应用于颈椎病实验研究。方法:应用计算机检索PubMed、Medline、Embase、Web of science、万方、维普和CNKI等数据库,英文检索词为“cervical spondylosis,cervical spondylotic myelopath,cervical spondylotic radiculopathy,cervical spondylosis of vertebral artery type,neck type cervical spondylosis,unbalanced dynamic and static forces,joint injury,neck pain,animal model”,中文检索词为“颈椎病,神经根型颈椎病,脊髓型颈椎病,椎动脉型颈椎病,颈型颈椎病,动静力失衡,关节损伤,颈痛,动物模型”,按照纳入和排除标准对文献进行筛选,最终纳入61篇文献进行综述。结果与结论:大鼠是最常用的动物,雄性大鼠似乎更受欢迎,推荐使用成年前后的动物。根据造模特点可以将颈椎病模型分为脊髓型、神经根型、颈型和其他型,不同造模方法各有优缺点。从已有动物模型的研究出发,总结了颈椎病的分子机制,治疗信号介导核因子κB、磷脂酰肌醇3-激酶/蛋白激酶B、丝裂原激活蛋白激酶等通路调节脊髓、神经根、椎间盘、肌肉等组织的炎症反应、凋亡、自噬等生物学过程,最终延缓颈椎病的进展。部分研究质量较差,与临床契合度不高,未来需要进一步将颈椎病动物模型标准化,制定相关指南,提高研究结果的可信度,为进一步开展人体临床试验奠定坚实的基础。

一种新型骶神经孔穿刺定位方法的初步确立

目的通过分析骶神经孔特征,确立一种新型的骶神经穿刺定位方法,帮助临床提高穿刺成功率。方法回顾性分析2019年1月—2022年8月山东大学齐鲁医院158例接受骶神经调控术(SNM)患者的临床资料和骶尾骨计算机断层扫描(CT)三维重建影像,在第3骶孔水平线测量一侧骶髂关节下缘至同侧第3骶孔内上缘距离(D1)、同侧第3骶孔内上缘至骶中线的水平距离(D2),计算二者比值(D1/D2),用于术中精确定位骶神经孔。分析本组患者的测量数据特点和穿刺结果。结果共纳入患者158例,其中男性89例,女性69例,平均年龄(49.0±16.9)岁,平均D1、D2、D1/D2分别为(29.6±4.9)mm、(13.8±3.2)mm、(2.2±0.6)。相较于男性患者,女性患者的D1[(28.7±4.2)mm vs.(30.7±5.5)mm,P=0.010]及D1/D2均较大[(2.1±0.5)vs.(2.4±0.7),P=0.001]。少年组D1小于成年组[(25.7±5.4)mm vs.(29.8±4.7)mm,P=0.006]。采用本定位方法在术中精确定位后,158例患者均穿刺成功,152例(96.20%)患者术中神经反应应答非常好,2例(1.27%)患者应答良好,4例(2.53%)患者应答一般。结论骶3神经定位点的位置大约位于骶髂关节下缘至骶中线连线中内1/3处。通过X线测量骶髂关节下缘至骶中线的水平距离,并在体表进行骶神经孔定位,有望成为辅助SNM中定位电极置入点的可靠方法。

脊髓及神经根缺血再灌注损伤机制及中药防治作用的研究进展

脊髓缺血再灌注损伤是脊柱减压手术或胸腹主动脉手术严重并发症之一,一旦出现则会引起脊髓、神经功能障碍、下肢瘫痪等严重后果。由于其复杂的发生机制,尽管目前的治疗措施包括高压氧、脊髓缺血预处理等在内的防治手段,但仍无法从根本上阻断脊髓缺血再灌注损伤的发展。在临床上,脊柱减压术后也常出现神经根继发性损伤。通过调研大量文献,梳理并总结脊髓缺血再灌注损伤的发生发展过程中可能的生理病理机制,包括氧化应激、炎症反应、细胞凋亡及离子过载等,并类比脊髓的缺血再灌注损伤,提出了神经根缺血再灌注损伤的概念。通过梳理临床上应用的补气活血类中药,揭示中药通过多成分、多途径、多靶点发挥协同治疗作用优势及其抗氧化、抗炎、抑制细胞过度凋亡、干预钙过载等方面作用机制,以期拓展脊髓及神经根缺血再灌注损伤研究的基础机制和科学用药,为中药的临床诊疗提供全面的依据和新思路。

脊柱内镜技术处理腰椎关节突关节毗邻出口神经根伴随动脉的解剖学应用研究

目的:探讨脊柱内镜技术处理腰椎关节突关节毗邻出口神经根伴随动脉的解剖学应用.方法:选择新鲜人体标本男、女各5具为研究对象.采取剥离显露腰椎脊柱及关节突关节周围组织结构方法,观察该区域血管形态、走行规律及与周围毗邻组织关系.结果:腰椎关节突关节毗邻出口神经根处血管网与内镜工作通道,或者环锯距离,在L3/4节段,男性为(11.39±0.72)mm,女性为(11.03±0.52)mm;在L4/5节段,男性为(11.78±1.26)mm,女性为(11.29±0.38)mm;在L5/S1节段,男性为(11.1±0.98)mm,女性为(10.45±0.45)mm.在男、女性的L3/4、L4/5及L5/S1节段中,该出口神经根处血管网与内镜工作通道或者环锯的距离左、右两侧比较,差异均无统计学意义(P>0.05).结论:采取人体尸体标本解剖研究,从开放角度探讨关节突关节毗邻出口神经根伴随动脉的走行与周围组织的关系,可指导施术者术中穿刺及工作通道置入,降低甚至避免术中出血量或术后血肿发生率.