基于三维编码系统的颈椎硬膜外导管末端空间分布规律及影响因素分析

Spatial Distribution and Influencing Factors of Cervical Epidural Catheter Tips Based on a Three?dimensional Coding System

摘要:

目的：慢性颈椎相关性疼痛是导致功能障碍和生活质量下降的常见原因，颈椎硬膜外置管阻滞是其有效治疗手段，但导管末端位置难以精确控制，影响疗效与安全性。本研究旨在利用创新的“硬膜外导管末端位置三维12区编码系统”，描述导管末端的空间分布规律，并探讨其影响因素。方法：我们对我院2024年286例接受连续颈椎硬膜外阻滞（C6-7穿刺）的慢性颈椎疼痛患者进行回顾性队列分析，通过术后X线片应用三维编码系统定位导管末端，并记录导管形态、患者基线资料及住院指标。结果：导管末端在纵向主要集中于C4-C5节段（70.6%），在横向呈右-中优势分布（88.5%），在矢状面主要位于后区（67.5%）；立体核心靶区为“C4-M-P”（19.2%）和“C5-M-P”（14.7%），共占33.9%。多因素Logistic回归分析表明，较高的体重指数（Body mass index, BMI）是导管末端难以抵达理想区（定义为Cx-M-P）的独立危险因素（OR=0.882， P=0.026），而正位片上导管呈“直”形则是强保护因素（OR=5.267， P=0.005）。导管在正侧位片上呈“弯曲”形态与偏离理想区显著相关（P<0.001）。然而，导管是否位于理想区并未导致住院天数与费用的显著差异（P>0.05），且所有患者均未发生严重早期并发症。结论：本研究首次系统描绘了颈椎硬膜外导管末端的三维空间分布图谱，并明确了较高的BMI和导管形态呈直形是影响其位置的关键因素。

Abstract:

Objective:Chronic cervical spine-related pain is a common cause of functional impairment and reduced quality of life. Cervical epidural catheter block is an effective treatment, but precise control of the catheter tip position is difficult, affecting efficacy and safety. This study aimed to utilize an innovative "Three-dimensional 12-Zone Coding System for Epidural Catheter Tip Position" to describe the spatial distribution pattern of catheter tips and explore influencing factors.Methods: We conducted a retrospective cohort analysis of 286 patients with chronic cervical pain who underwent continuous cervical epidural block (C6-7 puncture) at our hospital in 2024. The catheter tip position was localized on postoperative X-rays using the 3D coding system. Catheter morphology, patient baseline data, and hospitalization indicators were recorded.Results: Catheter tips were primarily concentrated at the C4-C5 levels longitudinally (70.6%), showed a right-central dominance transversely (88.5%), and were mainly located in the posterior zone sagittally (67.5%). The core stereotactic target areas were "C4-M-P" (19.2%) and "C5-M-P" (14.7%),accounting for 33.9%. Multivariate logistic regression analysis indicated that a higher Body Mass Index (BMI) was an independent risk factor for the catheter tip failing to reach the ideal zone (defined as Cx-M-P) (OR=0.882, P=0.026), while a "straight" catheter shape on the anteroposterior X-ray was a strong protective factor (OR=5.267, P=0.005). A "curved" catheter morphology on lateral X-rays was significantly associated with deviation from the ideal zone (P<0.001). However, whether the catheter was in the ideal zone did not lead to significant differences in hospital stay length or cost (P>0.05), and no serious early complications occurred in any patient.Conclusion: This study is the first to systematically map the three-dimensional spatial distribution of cervical epidural catheter tips and identifies higher BMI and a straight catheter shape as key influencing factors.