1047例中国人的MRI，观察脊髓圆锥中止的位置（CMT）

mazuilv

Is spinal anaesthesia at L2–L3 interspace safe in disorders of the vertebral column? A magnetic resonance imaging study

在脊髓圆锥发生错位的情况下
使用L2–L3间隙行腰麻
是安全的吗？一篇磁共振成像的研究。
Background

The varying point at which the spinal cord terminates in the lumbar spinal canal may affect the incidence of spinal cord injuries associated with needle insertion for spinal anaesthesia, especially in patients with vertebral body or intervertebral disc disease.在行腰麻时，由于腰段脊髓圆锥终止的位点不同，可能会带来由穿刺针造成的脊髓的损伤，特别是合并椎体或者椎间盘病变的病人。

This is a complication which has been frequently reported when spinal needle insertion was performed at higher lumbar spinal levels.在高位脊髓水平的腰麻穿刺中，已经频繁的报道有相关的并发症发生。
Methods We retrospectively reviewed magnetic resonance images of the spine in 1047 Chinese patients to determine the conus medullaris terminus (CMT) in patients with and without vertebral disorders.我们回顾性的分析了1047中国病人的脊髓磁共振成像，确定脊髓圆锥是否有错位

Patients with tumours in and around the spine and those with congenital spinal anomalies were excluded from the study. Patients with mixed vertebral disorders were also excluded. 在脊髓旁边或里面合并肿瘤的病人，排除脊髓先天性异常椎体畸形的也排除
Results Our data demonstrate that patients with thoracic vertebral compression fractures had lower ending points of the CMT than those without (P<0.05), while patients with lumbar compression fractures did not demonstrate such a correlation. 我们的研究数据表明有胸段椎体压缩性骨折病人脊髓圆锥终止的更低，但是腰段椎体骨折的没有相关性。With regard to this difference, females were significantly at higher risk for a lower CMT than males. 至于不同点中
女性相对于男性具有高风险Conversely, lumbar disc disorders such as intervertebral disc extrusion, herniation, or bulging did not have any significant influence on the level of CMT.

相反地，腰椎间盘如椎间盘的突出，膨出不会对脊髓圆锥的水平有影响，Moreover, patients with spondylolisthesis or scoliosis did not demonstrate an abnormal CMT location.脊髓前移或者脊髓侧弯不能证明他们脊髓圆锥在正常水平，
Conclusions When performing spinal anaesthesia, anaesthesiologists should be aware of potential differences of the CMT location, particularly in female patients with thoracic vertebral compression fractures, who may have a lower CMT than normal, extending to the level of L2. Performing spinal anaesthesia at the L2–L3 interspace would seem to be ill-advised in this patient population.

在行腰麻的时候，麻醉医生应该意识到脊髓圆锥位置存在潜在的不同，特别是合并有胸段压缩性骨折的女性病人，可能合并有更低的脊髓圆锥终止水平，扩张到L2水平，在行腰麻，穿刺L2–L3间隙时，对于这类人群，我们应该是欠考虑的。

转接话题 自己翻译 水平有限 仅供参考。

苍耳

我前几天还在考虑这个问题，很深刻啊，确实该值得研究~~~

yuhbyuhb

可是我们不能把疑似对象都坐MRI吧，还是比较难

ztf

还是比较困难的，所以说腰硬联合麻醉穿刺点选择上，宁低勿高，平面可以调，置管可以适当长一些。安全第一。

无病呻吟

可是我们不能把疑似对象都坐MRI吧，还是比较难
yuhbyuhb 发表于 2010-11-28 01:30

                               
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   我们还没MRI呢。
平常选择都是L3~4