颈脊神经后内侧支阻滞的药物体积作为后期射频治疗成功的预测因素:一项尸体研究

Cervical medial branch block volume as a predictor of radiofrequency treatment success: a cadaveric study

摘要:

目的 探讨0.5和1mL注射液在颈脊神经后内侧支阻滞时体积扩散度的差异。方法 这是一项尸体研究，选择了10具颈椎完整的受试者。随机分两组，1ml组（n=5）应用超声平面外引导技术采用侧入路进行颈脊神经后内侧支阻滞，以单点颈脊神经后内侧支为穿刺靶点，给予1 mL 1%医用级亚甲蓝溶液。0.5ml组（n=5）应用超声平面外引导技术采用侧入路进行颈脊神经后内侧支阻滞，以单点颈脊神经后内侧支为穿刺靶点，给予0.5 mL 1%医用级亚甲蓝溶液。注射后进行大体解剖，以评估注射液扩散范围（覆盖射频靶点的邻近结构情况）。 结果 注射后尸体解剖发现，尽管两种药液体积均可以充分覆盖了对应节段颈脊神经后支，但1ml组可向背侧扩散至浅层肌肉和远离靶点的上下多节段神经，而0.5ml组药液基本在与目标靶点并列的颈深肌层及颈中肌层中，且基本集中于靶点上下节段神经区域。结论 在颈脊神经后内侧支阻滞期间注射1mL局麻药可扩散至许多非预期目标神经节段，从而降低了诊断性注射的特异性；而0.5 mL注射液就可以有效覆盖目标节段颈脊神经后内侧支。这样减少了药物对非靶点组织的作用，增加了诊断性颈脊神经后内侧支阻滞的特异性，并可对进一步的射频治疗成功提供更可靠的依据。

Abstract:

To investigate the difference of volume spread between 0.5 and 1 mL injections during posteromedial branch block of the cervical spinal nerve. Methods This was a cadaveric study in which 10 subjects with intact cervical vertebrae were selected. They were randomly divided into two groups, 1 ml group (n = 5) was treated with lateral approach for posteromedial branch block of the cervical spinal nerve using ultrasound out-of-plane guidance technique, and 1 mL of 1% medical grade methylene blue solution was given using the posteromedial branch of the cervical spinal nerve at a single point as the puncture target. In the 0.5 ml group (n = 5), ultrasound out-of-plane guidance technique was used to perform posteromedial branch block of the cervical spinal nerve using a lateral approach, and 0.5 mL of 1% medical-grade methylene blue solution was given using the posteromedial branch of the cervical spinal nerve at a single point as the puncture target. Gross anatomy was performed after injection to assess the extent of injection spread (adjacent structures covering the radiofrequency target). Results Autopsy after injection revealed that although the posterior branch of the cervical spinal nerve at the corresponding segment could be fully covered by the volumes of the two solutions, the 1 ml group could spread dorsally to the superficial muscles and the upper and lower multilevel nerves away from the target, while the 0.5 ml group could basically be in the deep cervical muscle layer and middle cervical muscle layer juxtaposed to the target target, and basically concentrated in the nerve regions at the upper and lower segments of the target. Results Autopsy after injection revealed that although the posterior branch of the cervical spinal nerve at the corresponding segment could be fully covered by the volumes of the two solutions, the 1 ml group could spread dorsally to the superficial muscles and the upper and lower multilevel nerves away from the target, while the 0.5 ml group could basically be in the deep cervical muscle layer and middle cervical muscle layer juxtaposed to the target target, and basically concentrated in the nerve regions at the upper and lower segments of the target.