| 摘要: |
| 目的 探讨体表标志触诊定位及超声辅助定位胸椎水平的准确性和优劣性。方法 选择择期行脊柱手术的患者48例，男性19例，女性29例，美国麻醉师协会（American Society of Anesthesiologists，ASA）分级Ⅰ～Ⅲ级。由一名熟练触诊定位的麻醉医师通过体表标志触诊定位C7棘突后，向尾侧依次触诊直至确定T7棘突位置并依此标记定为T7a。之后由另一名熟练脊柱超声的麻醉医师使用低频凸阵探头横切面放置于颈椎水平上下扫查，确定C7棘突后，超声向尾侧扫查确定T1棘突和横突位置并标记，再依次扫查确定T7横突位置，以此并标记T7b。最后由脊柱外科医师通过C臂机拍摄图像确定T7的准确位置，以判定T7a和T7b的定位是否正确。并探索体重指数（Body Mass Index，BMI）和年龄对两种定位方法准确性的影响。结果 超声辅助定位法准确率显著高于体表标志触诊法，分别为85.4% vs.52.1% （P＜0.05）；超声辅助定位法相较于体表标志触诊法而言降低了个体差异对定位的影响；BMI和年龄对两种定位方法准确性的影响均无统计学意义。结论 超声辅助定位法优于体表标志触诊法。 |
| 关键词: 体表标志 触诊 定位 超声 胸椎水平 |
| DOI： |
| 投稿时间：2020-02-15修订日期：2021-03-20 |
| 基金项目: |
|
| Study on the accuracy of palpation and ultrasound-assisted localization of thoracic vertebrae with body surface markersZHANG Xiaodan,WANG Hongyu,GAO Yujie,HAN Liu |
| zhangxiaodan,WANG Hongyu,GAO Yujie,HAN Liu |
| (NANJING MEDICAL NUIVERSITY NANJING FIRST HOSPITAL(NANJING FIRST HOSPITAL)) |
| Abstract: |
| Abstract Objective Discuss the accuracy and advantages and disadvantages of palpation positioning and ultrasound-assisted positioning of the thoracic vertebral body level. Methods A total of 48 patients undergoing elective spinal surgery were selected, including 19 males and 29 females. The ASA classification was Ⅰ～Ⅲ. After spinous process of C7 was identified by palpation by a skilled anesthesiologist, palpation was performed to the tail side until spinous process of T7 was identified and marked and the position of T7a was determined according to this mark. Later, another anesthesiologist skilled in spinal ultrasound used a low-frequency convex array probe to place the coronal scan at the level of the cervical spine up and down to determine the C7 spinous process position. Ultrasound caudal scan to determine the position of the T1 spinous process and transverse process and mark, and then scan to determine the position of the T7 transverse process, and mark T7b. Finally, the spine surgeon uses the C-arm machine to take images to determine the exact position of T7 to determine whether the positioning of T7a and T7b is correct. Results The accuracy rate of ultrasound-assisted localization was significantly higher than that of body surface landmark palpation, 85.4% vs 52.1% （P＜0.05）. Compared with the body surface mark palpation method, the ultrasound-assisted positioning method reduces the influence of individual differences on the positioning; The influence of BMI and age on the accuracy of the two positioning methods is not statistically significant. Conclusion Ultrasound-assisted localization is superior to body surface landmark palpation. |
| Key words: Surface landmark Palpation Identification Ultrasound Thoracic spine level |
