2017骶丛坐骨神经阻滞刘扬课件.pptx

骶丛、坐骨神经阻滞2007北京朝阳医院麻醉科刘扬CONTENTS01适应证02解剖03阻滞四种方法04小结骶丛神经阻滞适应证坐骨神经阻滞适应证? 单独阻滞：膝关节以下部位除了小腿 内侧条状带之外区域的小腿、足、踝、 跟腱不同类型手术提供麻醉和镇痛；? 联合应用（腰丛、髂腹下神经、股外 侧皮神经、股神经、闭孔神经）：髋 部、膝关节和大腿前后的手术? 臀部和坐骨神经支配区域 的疼痛治疗? 膝关节以下部位除了小腿 内侧条状带之外区域的手 术麻醉和镇痛? 联合腰丛阻滞可用于髋关节和更近端下肢手术麻醉Anatomy）骶从(sacral Plexus)是由L4-5，全部骶神 经和尾神经前支组成重要分支：臀上神经（Gluteal nerve superior臀下神经（Gluteal nerve inferior股后皮神经（Posterior femoralcutaneous nerve）阴部神经（Pudendal nerve）坐骨神经（Sciatic nerve）GGPPS坐骨神经(sciatic nerve) 是由L4、5，S1～3脊神经前支组成坐骨神经? 经坐骨结节和股骨大转子之间，在臀大肌深面、股方肌浅面下行? 沿大腿后坐骨神经上部的内侧有股后皮神经和臀下动脉伴行? 行至在腘窝横纹上方5～12cm ，分为胫神经和腓总神经胫神经（tibial nerve）? 分为足底内侧神经和足底外侧神经二终支? 胫神经在腘窝及小腿还发出肌 支支配小腿肌后群? 胫神经发出腓肠内侧皮神经，在小腿下部与腓肠外侧皮神经（发自腓总神经）吻合成腓肠 神经，经外踝后方弓形向前，分布于足背和小趾外侧缘的皮肤。腓总神经（ common peroneal nerve）? 自坐骨神经发出后沿股二头肌内 侧走向外下，绕腓骨颈外侧向前， 穿腓骨长肌分为腓浅和腓深神经? 腓总神经的分布范围是小腿前、 外侧群肌和小腿外侧、足背和趾 背的皮肤感觉支配坐骨神经感觉和肌肉支配1、骶旁神经丛阻滞neuroaxial block臀上区短轴扫描LateralMedial臀中区短轴扫描MedialLateral臀中区长轴Gaata TrochantsrUltrasound Localization of the Sacral Plems Using a Parasacral Approachtm nsduotIn this repor(, we describe the feasibility of l?x:ating the sacral plexus nerve using a parasacral approach and an ultrasound-guided technique. The parasacral region using a curved probe (2—S MHz) was scanned in 17 patients iii search of the medial border of the ischial bone and the lateral border of the sacrtim, which represent the limit of the greater sciatic foremen. In addition, attempts were made to identify the pirikirrriis muscles and the gluteal arteries. Tue sacral plexus was identified at the level of tire sciatir fnramen as a round hyperechoic structure. The gluteal arteries were identified in 10 of 17 patients, but we faded to positively identify the pirif-oriiiis oiusck in any pafienL To con￡ m localization of the sacral plexus, an insulated needle attached to a nerve stimulates was advanced and, in each case, a sacralAlon Y. Ben-Azi, M?Rama Joshi, lvIOAnna lJskova, InfoJacques E. Chelly, MD