体位对老年患者腰椎间隙黄韧带长度超声测值的影响

魏辉明; 李治贵; 王玲玲; 曹霖; 晏毅

doi:10.12259/j.issn.2095-610X.S20220422

体位对老年患者腰椎间隙黄韧带长度超声测值的影响

doi: 10.12259/j.issn.2095-610X.S20220422

解放军联勤保障部队第920医院麻醉科，云南昆明　650032

基金项目: 原成都军区医学科研重点基金资助项目（B14013）

详细信息

作者简介:
魏辉明（1965～），男，广东五华人，医学博士，主任医师，主要从事麻醉临床及镇痛研究工作

通讯作者:
晏毅，E-mail：2832362@qq.com

中图分类号: R614
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出版历程
- 收稿日期: 2022-01-01
- 网络出版日期: 2022-03-23
- 刊出日期: 2022-04-25

Effect of Position on Ultrasonographic Measurement of Ligamentum Flavum Length of Lumbar Intervertebral Space in the Elderly Patients

Dept. of Anesthesiology, The 920 Hospital of Joint Service Support Army of PLA, Kunming Yunnan 650032, China

摘要

摘要: 目的探讨体位对老年患者腰椎间隙黄韧带长度超声测值的影响。方法选择年龄超过65岁拟行腰椎管内阻滞的老年患者40例，以旁正中矢状斜切面超声扫查坐位与左侧卧位下腰3/4、腰4/5、腰5/骶1椎间隙。测量并记录各间隙黄韧带前缘长度（anterior edge length of the ligamentum flavum，ALL）及皮肤至黄韧带前缘距离（distance from skin to the ligamentum flavum，DSL）；评估并记录图像清晰度。结果与左侧卧位测值比较，坐位下腰5/骶1 ALL长，且长于坐位腰3/4值（P < 0.05）；与腰3/4测值比较，坐位下腰5/骶1 DSL值浅（P < 0.05）。与腰5/骶1声图像比较，坐位与左侧卧位下腰3/4、4/5间隙左右两侧清晰度良好率较低（P < 0.05）。结论老年患者坐位下腰5/骶1 ALL超声测值长于左侧卧位相应值，也长于同一体位下腰3/4、腰4/5值，且其深度及声图像较其它间隙浅而清晰；建议此类患者采用旁正中穿刺入路行椎管内阻滞时，坐位下选择相对浅宽的腰5/骶1，左右两侧相当，尤其超声引导下。
- 体位 /
- 老年人 /
- 黄韧带 /
- 超声
Abstract: Objective To investigate effect of body position on ultrasonographic measurement of ligamentum flavum lengthin lumbar intervertebral space in the elderly patients. Methods 40 patients over 65 years of age who underwent spinal anesthesia were selected to examine the L 3/4, L 4/5 and L 5 / S1 intervertebral spaces. Anterioredge length oftheligamentum flavum （ALL） and distance from skin to theligamentum flavum （DSL） of L3/4, L4/5 and L5/S1 intervertebral spaces were measured by ultrasonic parasagittal oblique view in both sitting and left lateral decubitus position, and definition degree of each ultrasonic image were analyzed. Results Compared with the measurement in left lateral position, ALL at L5/S1 level in sitting position was longer, and longer than that at L3/4 in the same position （P < 0.05）; DSL at L5/S1 was lower than that at L3/4 in sitting position （P < 0.05）. Compared with ultrasonic definition of L5/S1, the fine definition rate of the left and right sides of L3/4 and L4/5 in both positions was lower （P < 0.05） . Conclusion The ALL ultrasonic measurement at L5/S1 level in sitting position was longer than that in left lateral decubitus position, and also longer than that at L3/4 and L4/5 in the same position, its depth and image were shallower and clearer than other spaces. It is recommended for elderly patients to use the paramidian puncture approach for lumbar anesthesia. The relatively shallow width of L5/ S1 should be selected under the sitting position, and the left and right sides are equivalent, especially under the guidance of ultrasound.
- Position /
- Elderly /
- Ligamentum flavum /
- Ultrasonography

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图 1 侧卧位下腰3/4左旁正中矢状斜切面声像图

Figure 1. Left parasagittal oblique view of L3/4 in lateral decubitus position

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表 1 不同体位下各间隙两侧ALL、DSL、DSA测值的比较[（$\bar x \pm s $） mm]

Table 1. Comparison of ALL，DSL and DPM measurements of both sides in different positions [（$\bar x \pm s $）mm]

指标与部位		坐位			左侧卧位			F	P
指标与部位		腰3/4	腰4/5	腰5/骶1	腰3/4	腰4/5	腰5/骶1	F	P
ALL	左	7.7 ± 3.1	9.7 ± 3.4	12.1 ± 2.3^*#	7.1 ± 2.7	7.9 ± 2.6	9.4 ± 3.0	17.918	0.001
	右	7.9 ± 3.0	9.8 ± 2.9	11.6 ± 2.4^*#	6.7 ± 3.0	7.5 ± 3.2	9.4 ± 2.1	16.514	0.001
DSL	左	40.3 ± 4.7	35.2 ± 5.2	33.0 ± 4.9^#	37.8 ± 11.3	33.8 ± 4.6	32.4 ± 6.1	8.728	0.001
	右	39.7 ± 5.5	36.3 ± 4.5	32.1 ± 5.4^#	36.3 ± 4.5	34.4 ± 5.0	32.5 ± 5.3	12.614	0.001
DPM	左	12.3 ± 3.1	13.5 ± 3.4	14.4 ± 3.7	13.3 ± 3.4	13.0 ± 3.1	15.0 ± 3.9	3.199	0.008
	右	14.1 ± 3.6	13.1 ± 4.0	13.7 ± 4.0	12.9 ± 3.9	12.5 ± 2.8	14.5 ± 4.2	1.633	0.152
与左侧卧位腰5/骶1值比较，^*P < 0.05；与腰3/4值比较，^#P < 0.05。

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表 2 不同体位下各间隙两侧声图像清晰度比较[n（%）]

Table 2. Comparison of ultrasonographic definition of each intervertebral space in different positions [n（%）]

部位与清晰度		坐位			左侧卧位			χ²	P
部位与清晰度		腰3/4	腰4/5	腰5/骶1	腰3/4	腰4/5	腰5/骶1	χ²	P
左	良好	19（47.5）^*	21（52.5）^*	32（80.0）	18（45.0）^*	22（55.0）^*	31（77.5）	17.089	0.004
	一般	5（12.5）	5（12.5）	2（5.0）	7（17.5）	5（12.5）	1（2.5）
	差	16（40.0）	14（35.0）	6（15.0）	15（37.5）	13（32.5）	8（20.0）
右	良好	18（45.0）^*	20（50.0）^*	30（75.0）	19（47.5）^*	21（52.5）^*	32（80.0）	18.521	0.002
	一般	8（20.0）	5（12.5）	6（15.0）	11 （27.5）	5（12.5）	2（5.0）
	差	14（35.0）	15（37.5）	4（10.0）	10 （25.0）	14（35.0）	6（15.0）
与腰5/骶1比较，^*P < 0.05。

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表 3 声像图清晰度良好患者各间隙两侧ALL、DSL、DPM测值比较[（$\bar x \pm s $），mm]

Table 3. Comparison of ALL，DSL and DPM measurements on both sides of each space in patients with fine ultrasonographic definition in different positions [（$\bar x \pm s $），mm]

部位与指标		坐位			左侧卧位			F	P
部位与指标		腰3/4	腰4/5	腰5/骶1	腰3/4	腰4/5	腰5/骶1	F	P
左	n	19	21	32	18	22	31
	ALL	7.8 ± 3.6	10.1 ± 4.0	12.3 ± 3.1^*#	7.3 ± 3.2	8.4 ± 3.0	9.1 ± 2.9	8.067	0.001
	DSL	41.2 ± 3.9	36.1 ± 6.3	33.2 ± 4.7^#	37.7 ± 9.7	33.8 ± 4.6	33.2 ± 5.6	6.397	0.001
	DPM	11.8 ± 3.2	13.0 ± 3.6	13.8 ± 3.9	12.9 ± 4.3	13.4 ± 4.0	14.3 ± 3.6	1.211	0.307
右	n	18	20	30	19	21	32
	ALL	7.6 ± 3.2	9.7 ± 3.2	11.9 ± 3.6^*#	6.8 ± 3.4	7.4 ± 3.4	9.2 ± 3.0	8.136	0.001
	DSL	40.1 ± 5.6	36.8 ± 6.1	33.8 ± 5.8^#	36.9 ± 4.9	34.7 ± 4.7	32.9 ± 5.9	4.929	0.001
	DPM	13.7 ± 4.1	13.5 ± 4.5	13.2 ± 3.3	13.2 ± 4.0	12.7 ± 3.2	14.6 ± 4.1	0.763	0.578
与左侧卧位腰5/骶1值比较，^*P < 0.05；与腰3/4值比较，^#P < 0.05。

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