论文部分内容阅读
目的:超声下观察头半棘肌平面(SCP)的解剖学特点,为临床有效实施超声引导下SCP阻滞提供参考。方法:健康成年志愿者30名(60侧)项区SCP的6个区域进行超声检查,重点检查与描述头半棘肌(SCA)、SCA深面间隙及间隙内结构的解剖学特点。结果:(1)项区寰椎后弓处横切超声图像显示SCA肌腹被一斜行筋膜分隔为内侧头和外侧头;在SCA-头下斜肌(OCI)间隙内可见第3枕神经(TON)和枕大神经(GON)被一筋膜分隔,二者之间常有枕静脉属支穿行,TON与GON间距为(12.9±0.6) mm。(2)项区枢椎椎弓板处横切超声图像显示SCA肌腹短轴与SCA-OCI间隙内结构特点同结果(1),TON与GON间距为(12.1±0.5) mm。(3)项区枢椎棘突旁纵切超声图像显示一附着于枢椎棘突末端的致密筋膜插入SCA肌腹内,将其分隔为上腹和下腹。(4)颞骨乳突下方颈n 2,3小关节处纵切超声图像显示SCA深面OCI-颈n 2,3小关节间隙内TON与GON之间未见明显分隔筋膜,两者间距为(8.0±0.5) mm。(5)项区颈4椎弓板处横切超声图像显示SCA-颈半棘肌间隙内可见颈深动、静脉穿行,未见颈4神经后支显示,SCA肌腹短轴特点同结果(1)。(6)项区颈5椎弓板处横切超声图像特点同结果(5),未见颈5神经后支显示。n 结论:超声下SCP内富含分隔筋膜,SCA深面间隙内常有血管穿行,其解剖结构复杂且存在个体差异,掌握其超声解剖学特点有助于安全、有效地实施超声引导SCP阻滞。“,”Objective:To observe the anatomical characteristics of the semispinalis capitis plane (SCP) to provide a reference for clinically effective implementation of ultrasound-guided SCP block.Methods:Ultrasound scanning was performed in six certain districts of SCP in 30 healthy volunteers (60 sides). The key point was to examine and describe the anatomical characteristics of semispinalis capitis (SCA), deep space of SCA and structures within the space.Results:(1) Transverse scanning at the posterior arch of atlas revealed that the SCA was separated into medial and lateral head by an oblique thick septum; in the space between SCA and obliquus capitis inferior (SCA-OCI), the third occipital nerve (TON) and the greater occipital nerve (GON) were separated by a fascia.There was often a branch of occipital vein between them.The distance from TON to GON was (12.9±0.6) mm.(2) Transverse scanning at the lamina of axis revealed that the axial image of SCA and the structures in SCA-OCI space were similar to the results previously described in (1). The distance from TON to GON was (12.1±0.5) mm.(3) Sagittal scanning beside the spinous process of axis revealed that SCA was separated into superior and inferior belly by a septum which connected to the end of axis spinous process.(4) Sagittal scanning at the Cn 2, 3 facet joint revealed that in the space between OCI and Cn 2, 3 facet joint (OCI-Cn 2, 3) beneath SCA, there was no septum between TON and GON.The distance from TON to GON was (8.0±0.5) mm.(5) Transverse scanning at the lamina of Cn 4 revealed that in the space between SCA and semispinalis cervicis, the deep cervical artery and vein were observable except medial branch of Cn 4, and the characteristics of the short axis of the SCA belly were similar to the results previously described in (1). (6) Transverse scanning at the lamina of Cn 5 revealed that the view was similar to the results previously described in (5). The posterior branch of Cn 5 nerve was not found.n Conclusions:SCP is rich in fascia, and blood vessels often pass through the deep surface space of SCA under ultrasound.The anatomical structure is complex, and there is individual variation.Grasping its ultrasonic anatomical characteristics is helpful in safely and effectively implementing ultrasound-guided SCP block.