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目的观察测量前锯肌间隙美兰溶液扩散范围及神经分布,为该间隙神经阻滞提供解剖学依据。方法选用4具尸体,应用超声引导技术,采用Blanco穿刺入路,在胸壁两侧腋中线4、5肋间,注入含美兰染料的液体(0.4 ml/kg)至前锯肌间隙,约10 min后逐层分离至该间隙,观察美兰液体的扩散范围、染料沉积后界限以及该范围内的神经分布。结果观察8侧前锯肌,逐层掀开胸大肌和胸小肌后,清晰显露前锯肌间隙的蓝染区域及区域内蓝染的2~6肋间神经的外侧皮支、胸长神经和胸背神经。中位数M(P25,P75)描述8个前锯肌筋膜间隙注射扩散范围测量结果,腋前线11.35(10.45,12.15)cm,腋中线12.6(12.12,13.15)cm,腋后线11.1(10.70,12.05)cm,平乳头线9.8(9.12,10.65)cm。头侧扩散至第2肋腋前线占75%,腋中线占87.5%,腋后线占87.5%;扩散至第3肋腋前线占25%,腋中线占12.5%,腋后线占12.5%。结论前锯肌间隙美兰溶液扩散范围解剖测量研究提示临床应用此方法进行前锯肌间隙神经阻滞,可阻滞前锯肌间隙内的2~6肋间神经外侧皮支、胸长神经和胸背神经,满足胸前外侧壁手术的麻醉和镇痛。
Objective To observe the range and distribution of melanin solution in serratus anterior interosseous mesenchyme, and to provide anatomic evidence for the interspace nerve block. Methods Four corpses were selected. Blanco puncture was applied with ultrasound guided technique. Liquids (0.4 ml / kg) containing melanin dye were injected into the space of the anterior serratus anterior intercostal space at the interciliary axillary line 4 and 5 on both sides of the chest wall. min, and then separated to the gap layer by layer to observe the diffusion range of the Meilan liquid, the boundary after the deposition of the dye and the nerve distribution within the range. Results After observing the serratus anterior serratus on the 8 sides, the pectoralis major and pectoralis minor were opened one by one and the outer scalp and the chest length of the 2 ~ 6 intercostal nerves in the anterior serratus muscle were clearly revealed. Nerve and thoracodorsal nerve. Median M (P25, P75) Described the measurement results of the range of injection and diffusion of the 8 anterior myofascial space, axillary line 11.35 (10.45,12.15) cm, axillary line 12.6 (12.12,13.15) cm, axillary line 11.1 (10.70 , 12.05) cm, flat nipple line 9.8 (9.12,10.65) cm. Head to the second rib axillary line accounted for 75%, axillary line accounted for 87.5%, 87.5% of the axillary line; spread to the third rib axillary line accounted for 25%, axillary line accounted for 12.5%, axillary line accounted for 12.5%. Conclusions The anatomical study on the diffusion range of Melania solution in the anterior serratus myxoidis suggests that the clinical application of this method to the anterior serrated interosseous nerve block can block the 2 ~ 6 intercostal nerve cutaneous branches, Thoracic and dorsal nerves to meet the anesthesia and analgesia of the lateral thoracic wall surgery.