【超声频道】超声引导下股神经及其分支阻滞（下）
超声引导下股神经阻滞术后镇痛：股神经阻滞已经作为一种安全有效的术后镇痛方式广泛的运用在下肢手术。
04
超声下血管旁三合一（股）神经阻滞
血管旁法腰丛神经阻滞（即三合一）是基于以下设想：向股管内注射大容量局麻药同时压迫股管远端，使局麻药向近端扩散进入腰肌间隙从而阻滞腰丛神经[16]。但影像学研究认为，上述注射的局麻药向内外两侧扩散的同时也阻滞了内侧的闭孔神经和外侧的股外侧皮神经[17]。方法与股神经阻滞相似，在阻滞股神经时在远端进行加压处理使局麻药能很好的扩散达到阻滞另外两条神经的效果。或者通过超声的影像依次找到三条神经分别进行阻滞。
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隐神经阻滞
隐神经解剖：隐神经是股神经的终末感觉分支。它支配大腿、踝和足的内侧。隐神经阻滞可以很好的应用于该区域的表浅手术；当足、踝部手术涉及内侧时，隐神经阻滞是对坐骨神经阻滞的最佳补充。收肌管是一个横截面为三角形的管状间隙，位于大腿的中段，收肌管由缝匠肌、股内侧肌和内收肌群（长收肌和大收肌）包绕而成，向上连接股三角、向下连接腘窝，股血管和隐神经走形于内。隐神经在超声图像上经常不能显示，有时可见于股动脉附近，为一小的圆形高回声结构。在膝关节以上：隐神经出现在缝匠肌与股内收肌之间（图17）。在膝关节以下：隐神经沿着胫骨走行，并与皮下的大隐静脉伴行（图18）。在踝关节水平：隐神经发出的一个分支在皮下隐静脉的内侧。
图17：大腿水平隐神经的断层解剖[6]
图18：胫骨粗隆水平隐神经断层解剖[6]
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收肌管阻滞
图19：收肌管阻滞的探头和针位置[11]
图20：收肌管阻滞超声图像
图21：收肌管阻滞解剖结构标注图
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静脉旁路法阻滞
图22：静脉旁路法隐神经阻滞的探头位置和进针点[6]
图23：静脉旁路法隐神经阻滞超声图像
图24：静脉旁路法隐神经阻滞解剖结构标注图
临床应用
参考文献
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