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신경근골격계 초음파 논문리뷰
글쓴이 : 관리자 날짜 : 2018-04-11 (수) 11:20 조회 : 602

신경근골격계 초음파 논문리뷰

+ 요추 경막외 주사 (inter-laminar paramedian approach) 를 위한 초음파 해부학

초음파를 이용한 요추 경막외 주사를 시행하는 의사가 적은 것은 spinal sonoanatomy에 대한 이해부족 때문이라 생각해서 'water-based spine phantom'을 이용한 paramedian sagittal scan의 초음파 영상에 대하여 설명하였다. L3-4L4-5 intervertebral space를 중심으로 phantom, 실제 사람의 이미지, 그리고 cadaveranatomical slice까지 세 개의 이미지를 동시에 비교하여 laminafacet joint, transverse process에서의 paramedian sagittal 초음파 영상을 설명하고 있다. phantom을 이용한 요추부의 osseous anatomy는 같은 부위에서는 일정한 패턴을 보이고 이것이 실제 사람의 영상과 잘 매칭되어 초음파 유도하 요추 경막외 주사를 위한 해부학적인 이해를 돕는다.

Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region

Br J Radiol. 2012 Jul;85(1015):e262-9

+ 요추 초음파 유도 하 (transforaminal) para-radicular injection에 대하여 paramedian sagittalparamedian sagittal oblique approach를 비교

초음파를 이용한 요추 nerve root block이나 transforaminal injection이 시행되는데 두 접근법에 대하여 조영제의 퍼짐을 fluoroscope으로 관찰하였다. 장축으로 요추의 레벨을 찾은 후 외측으로 초음파 탐촉자를 이동하여 facet joint에서 transverse process로 이행되는 부분까지 이른 후 피부에 수직으로(paramedian sagittal), 또는 내측으로 20도 정도 기울인 후(paramedian sagittal oblique) 주사바늘을 삽입하여 주사하였고 조영제의 퍼짐을 영상으로 확인하여 두 군 모두 90% 정도의 성공률을 보였고, 차이로는 기울인(oblique) 그룹에서 intraforaminal injection 된 비율이 87%로서 수직으로 접근한 비율 40%보다 유의하게 높았다. 이 논문을 통해 방법적인 차이보다 초음파를 이용한 유도시술 중 요추부의 transforaminal injection을 좀 더 자신감을 가지고 시도해 보길 바란다.

Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches.

Pain Pract. 2015 Nov;15(8):693-700

+ caudal block accidental intravascular injection과 연관된 risk factor

최근 초음파로 가이드하는 caudal block이 많이 시행되지만 혈관 내 주사를 확인할 수 없는 단점이 있어 혈관 내 주사의 빈도와 이러한 혈관 내 주사가 많이 될 수 있는 위험인자를 확인해 보고자 하였다. 시술을 받은 211명을 후향적으로 리뷰하여 약 42%에서 혈관 내 주입이 확인되었고 이는 시술 시 digital subtraction angiography로 혈관 내 주입을 microscopic 하게까지도 확인하여 기존의 flouroscopy보다 민감하게 검출하였다고 설명하며 혈관 내 주입 가능성이 높은 환자군을 만성 통증 환자 (symptom duration: 106vs 52)와 신경근 압박 증상이 있는 환자 (radicular symptom: 90% vs 76%)로 보고하였다. caudal block 시 혈관 내 주사에 대한 인식을 갖고, 특히 통증 기간이 오래된 환자와 신경근병증 환자에서 시술할 때 혈관 내 주사 가능성이 증가하며 이에 대한 합병증까지 염두에 두어야 할 것이다.

Risk factors related to accidental intravascular injection during caudal anesthesia.

J Anesth. 2014 Dec;28(6):940-3


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