肱动脉与正中神经解剖关系的超声影像评估及相关因素分析-东南大学学报医学版

肱动脉与正中神经解剖关系的超声影像评估及相关因素分析

单位：1. 南京医科大学附属南京医院/南京市第一医院麻醉科, 江苏南京 210006;
2. 江苏大学附属句容医院麻醉科, 江苏镇江 212400

分类号：R445.1

出版年·卷·期（页码）：2022·41·第六期（840-849）

摘要：

目的: 超声测量肘部肱动脉、正中神经的解剖参数,评估其空间关系,并总结相关因素对血管神经重叠的影响。方法: 纳入手术患者共100例,分别在中位线(肘横纹)、高位线(肘横纹近端2 cm)、低位线(肘横纹远端2 cm)3个穿刺水平超声测量肱动脉半径(RA)、横径(TDA)、皮肤垂直距离(VDA)和正中神经半径(RN)、横径(TDN)、皮肤垂直距离(VDN),判断正中神经与肱动脉的相对位置及重叠情况。比较左右侧及不同穿刺水平、性别、年龄、体质指数(BMI)者血管神经解剖参数和空间关系的差异。结果: (1) 右侧中位线水平TDA宽于低位线水平,TDN宽于高位线及低位线水平;左侧中位线及低位线水平TDN宽于高位线水平;双侧中位线及低位线水平TDA宽于高位线水平,中位线水平VDA和VDN最为表浅,上述差异均有统计学意义(P＜0.05)。(2) 正中神经多位于肱动脉的尺侧,但左侧高位线水平有18%的患者伴行于桡侧,明显高于右侧及同侧中、低位线(P＜0.01)。(3) 两侧中位线及左侧低位线水平,血管神经未重叠发生率明显高于高位线水平;右侧中位线水平未重叠发生率高于低位线。穿刺水平是影响血管神经重叠的独立因素。结论: 肘中位线水平肱动脉穿刺条件更佳,正中神经穿刺损伤风险低,高位线水平穿刺损伤风险高。

Objective: To measure the anatomical parameters of the brachial artery and median nerve in the elbow by ultrasonography, assess their spatial relationships and to analyze the irelated influencing factors on the overlap of vascular and nerve. Methods: A total of 100 surgical patients were included, and ultrasonography was used to respectively measure the radius(RA), transverse diameter (TDA), and vertical skin distance(VDA) of the brachial artery,and the radius(RN), transverse diameter(TDN), and vertical skin distance(VDN) of the median nerve at three puncture levels (median line: transverse elbow; high line: 2 cm proximal to the transverse elbow, and low line: 2 cm distal to the median) to determine the relative position and overlap of the median nerve and brachial artery. The differences between the right and left side, puncture level, gender, age, and BMI in vascular and nerve anatomical parameters and spatial relationships were compared. Results: (1) The TDA was wider at the right median level than that at the low level, and the TDN was wider at the right median level than that at the high and low levels; the TDN was wider at the left median and low levels than that at the high level; the TDA was wider at the bilateral median and low levels than that at the high level, and the VDA and VDN were most superficial at the median level.The differences were statistically significant(P＜0.05). (2) The median nerve was mostly located on the ulnar side of the brachial artery, but 18% of patients with the left high line level were accompanied by the radial side, which was significantly higher than that of the right side and the ipsilateral middle and low lines(P＜0.01). (3) The incidence of vascular-nerve non-overlap was significantly higher at the median line on both sides and at the left low line level than that at the high line level; the incidence of non-overlap was higher at the right median line level than that at the low line. The puncture level was an independent factor affecting the vascular-nerve overlap. Conclusion: The brachial artery puncture at the middle line of elbow is better, and the injury risk of puncture at median nerve and at the high line is respectively low and high.

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