Name: targeting gray rami communicantes in selective chemical lumbar sympathectomy
Uploaded: 2019-01-10T15:00:00
Description: Watch this Scientific Journal Video about Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy at JoVE.com

这项工作由北京大学第三医院归国学者科研基金会 (g批号: 77434-01, long zhang) 和北京高等教育青年精英教师项目 (批准书: yetp0072, 王文辉) 资助。

该议定书已得到当地医疗和道德委员会的批准。该程序持续约 15分钟, 每侧。
1. 适应症
<ol><li>确保患者有以下提示 cls: 血栓闭塞症 (buerger 病), 缺血性糖尿病足, 雷诺氏病, 足底多汗症, 红斑痛, 血栓形成, 幻肢疼痛, 或下角的生活网肌四肢。</li>
</ol>2. 禁忌症
<ol><li>如果满足以下任何禁忌症, 则排除患者: 脊柱畸形、出血倾向、过程中涉及的区域中的任何感染?...

<ol>
	<li>Karanth, V. K., Karanth, T. K., Karanth, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+sympathectomy+techniques+for+critical+lower+limb+ischaemia+due+to+non-reconstructable+peripheral+arterial+disease.">Lumbar sympathectomy techniques for critical lower limb ischaemia due to non-reconstructable peripheral arterial disease.</a> Cochrane Database of Systematic Reviews. 12, 011519 (2016).</li><li>Kothari, R., Maharaj, A., Tomar, T. S., Agarwal, P., Sharma, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+chemical+lumbar+sympathectomy+for+Buerger's+disease:+Results+in+147+patients.">Percutaneous chemical lumbar sympathectomy for Buerger's disease: Results in 147 patients.</a> Indian Journal of Vascular Endovascular Surgery. 4, 185-190 (2017).</li><li>Dong, G. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy.">Chemical lumbar sympathectomy.</a> Chinese Journal of Practical Surgery. 4, 245-246 (2004).</li><li>Dong, G. X., Zhao, J., Luan, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy+for+the+treatment+of+lower+limb+ischemia.">Chemical lumbar sympathectomy for the treatment of lower limb ischemia.</a> Chinese Journal of General Surgery. 1, 30-32 (2002).</li><li>Dong, G. X., Zhao, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+sympathectomy+for+ischemia+of+lower+extremity.">Chemical sympathectomy for ischemia of lower extremity.</a> Journal of Beijing Medical University. 1, 59-60 (1998).</li><li>Yoshida, W. B., Cataneo, D. C., Bomfim, G. A., Hasimoto, E., Cataneo, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy+in+plantar+hyperhidrosis.">Chemical lumbar sympathectomy in plantar hyperhidrosis.</a> Clinical Autonomic Research. 20 (2), 113-115 (2010).</li><li>Zhang, L., Wang, W. H., Li, L. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+remission+of+primary+erythermalgia+with+R1150W+polymorphism+in+SCN9A+after+chemical+lumbar+sympathectomy.">Long-term remission of primary erythermalgia with R1150W polymorphism in SCN9A after chemical lumbar sympathectomy.</a> European Journal of Dermatology. 20 (6), 763-767 (2010).</li><li>Cerci, F. B., Kapural, L., Yosipovitch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intractable+erythromelalgia+of+the+lower+extremities+successfully+treated+with+lumbar+sympathetic+block.">Intractable erythromelalgia of the lower extremities successfully treated with lumbar sympathetic block.</a> Journal of the American Academy of Dermatology. 69 (5), 270-272 (2013).</li><li>Wang, W. H., Zhang, L., Dong, G. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy+in+the+treatment+of+recalcitrant+erythromelalgia.">Chemical lumbar sympathectomy in the treatment of recalcitrant erythromelalgia.</a> Journal of Vascular Surgery. 0741 (18), 31639-31642 (2018).</li><li>Wang, W. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy+in+the+treatment+of+idiopathic+livedo+reticularis.">Chemical lumbar sympathectomy in the treatment of idiopathic livedo reticularis.</a> Journal of Vascular Surgery. 62 (4), 1018-1022 (2015).</li><li>Burn, J. M., Langdon, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hazard+of+chemical+sympathectomy.">Hazard of chemical sympathectomy.</a> British Medical Journal. 1 (6120), 1143 (1978).</li><li>Wijeyaratne, S. M., Seneviratne, L. N., Umashankar, K., Perera, N. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimal+access+is+not+maximal+safety:+pelviureteric+necrosis+following+percutaneous+chemical+lumbar+sympathectomy.">Minimal access is not maximal safety: pelviureteric necrosis following percutaneous chemical lumbar sympathectomy.</a> British Medical Journal Case Reports. , (2010).</li><li>Antao, B., Rowlands, T. E., Singh, N. P., McCleary, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pelviureteric+junction+disruption+as+a+complication+of+chemical+lumbar+sympathectomy.">Pelviureteric junction disruption as a complication of chemical lumbar sympathectomy.</a> Cardiovascular Surgery. 11 (1), 42-44 (2003).</li><li>Ranjan, P., Kumar, J., Chipde, S. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+renal+failure+due+to+bilateral+ureteric+necrosis+following+percutaneous+chemical+lumbar+sympathectomy.">Acute renal failure due to bilateral ureteric necrosis following percutaneous chemical lumbar sympathectomy.</a> Indian Journal of Nephrology. 22 (4), 292-294 (2012).</li><li>Cutts, S., Williams, H. T., Lee, J., Downing, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ureteric+injury+as+a+complication+of+chemical+sympathectomy.">Ureteric injury as a complication of chemical sympathectomy.</a> European Journal of Vascular and Endovascular Surgery. 19 (2), 212-213 (2000).</li><li>Ernst, S., Heindel, W., Fischbach, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+CT+guided+lumbar+sympathectomy:+our+own+experiences+and+literature+review.">Complications of CT guided lumbar sympathectomy: our own experiences and literature review.</a> Rofo. 168 (1), 77-83 (1998).</li><li>Daschner, H., Allgayer, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ureteral+obstruction+following+CT-guided+lumbar+sympathetic+exclusion.">Ureteral obstruction following CT-guided lumbar sympathetic exclusion.</a> Rofo. 161, 85-87 (1994).</li><li>Ryttov, N., Boe, S., Nielsen, H., Jacobsen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Necrosis+of+ureter+as+a+complication+to+chemical+lumbar+sympathectomy.+Report+of+a+case.">Necrosis of ureter as a complication to chemical lumbar sympathectomy. Report of a case.</a> Acta Chirurgica Scandinavica. 147 (1), 79-80 (1981).</li><li>Benchekroun, A., Lachkar, A., Soumana, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ureter+injuries.+Apropos+of+42+cases.">Ureter injuries. Apropos of 42 cases.</a> Annals of Urology. 31 (5), 267-272 (1997).</li><li>Coveliers, H., Meyer, M., Gharagozloo, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+selective+postganglionic+thoracic+sympathectomy+for+the+treatment+of+hyperhidrosis.">Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis.</a> Annals of Thoracic Surgery. 95 (1), 269-274 (2013).</li><li>Coveliers, H., Meyer, M., Gharagozloo, F., Wisselink, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+sympathectomy+for+hyperhidrosis:+technique+of+robotic+transthoracic+selective+postganglionic+efferent+sympathectomy.">Selective sympathectomy for hyperhidrosis: technique of robotic transthoracic selective postganglionic efferent sympathectomy.</a> European Journal of Cardio-thoracic Surgery. 43 (2), 428-430 (2013).</li><li>Akil, A., Semik, M., Fischer, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+Miniuniportal+Video-Assisted+Thoracoscopic+Selective+Sympathectomy+(Ramicotomy)+for+the+Treatment+of+Severe+Palmar+and+Axillar+Hyperhidrosis.">Efficacy of Miniuniportal Video-Assisted Thoracoscopic Selective Sympathectomy (Ramicotomy) for the Treatment of Severe Palmar and Axillar Hyperhidrosis.</a> Thoracic Cardiovascular Surgery. , (2018).</li><li>Sanderson, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy+with+radiological+assessment.">Chemical lumbar sympathectomy with radiological assessment.</a> Annals of the Royal College Surgeons of England. 63 (6), 420-422 (1981).</li><li>Lee, K. S., Su, Y. F., Lieu, A. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+outcome+of+percutaneous+computed+tomography-guided+chemical+lumbar+sympathectomy+for+patients+with+causalgia+after+lumbar+discectomy.">The outcome of percutaneous computed tomography-guided chemical lumbar sympathectomy for patients with causalgia after lumbar discectomy.</a> Surgical Neurology. 69 (3), 274-280 (2008).</li><li>Reid, W., Watt, J. K., Gray, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phenol+injection+of+the+sympathetic+chain.">Phenol injection of the sympathetic chain.</a> British Journal of Surgery. 57 (1), 45-50 (1970).</li><li>Haynsworth, R. F., Noe, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+lumbar+sympathectomy:+a+comparison+of+radiofrequency+denervation+versus+phenol+neurolysis.">Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis.</a> Anesthesiology. 74 (3), 459-463 (1991).</li><li>Boas, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sympathetic+blocks+in+clinical+practice.">Sympathetic blocks in clinical practice.</a> International Anesthesiology Clinics. 16 (4), 149-182 (1978).</li><li>Duncan, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemical+lumbar+sympathectomy.">Chemical lumbar sympathectomy.</a> Journal of Bone and Joint Surgery. 67 (2), 174-175 (1985).</li><li>Marhold, F., Izay, B., Zacherl, J., Tschabitscher, M., Neumayer, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thoracoscopic+and+anatomic+landmarks+of+Kuntz's+nerve:+implications+for+sympathetic+surgery.">Thoracoscopic and anatomic landmarks of Kuntz's nerve: implications for sympathetic surgery.</a> Annals of Thoracic Surgery. 86 (5), 1653-1658 (2008).</li></ol>

在这里, 我们将 cls 归类为常规或选择性 cls, 主要区别是针对交感神经主干与灰色的 rami 通信 (在前筋膜的前面注射苯酚与前筋膜后面的腰主要肌肉)。我们在年轻的女性网状子宫肌细胞患者、7、9例红血球和晚期动脉硬化闭塞症和高危合症患者中实施了选择性 cls,我们已经确认了它持久、有益的效果和安全性。
<p class="jove_content...

化学腰椎交感神经切除术 (cls) 已被证明是一种有效的治疗缺血性疾病1,2,3,4, 5包括血栓闭塞症 (有时称为 buerger 病), 缺血性糖尿病足, 雷诺氏病, 足底多汗症6, 红血球痛7,8,9, 和生活网状 10.由于一些优点, 它取代了开放手术。它是微创和经济上有吸引力, 它不需要全身麻醉和住院, 它可以反复进行。然而, 精致的精度是至关重要的。例如, 在 cls 中使用盲技术11 报告了截瘫。通过放射线引导, 通过使用造影剂显示治疗区域, 极大地提高了手术的精度, 从而控制了穿刺针尖的准确位置以及穿刺路径和深度。然而, 即使有放射引导, 对邻近器官, 特别是输尿管器官的损害 12,13,14,15, 16, 1 7、1 8、1 9岁仍有报道。
它是通常练习定位针尖以外的前筋膜的腰主要肌肉和注射药物周围的交感神经树干8,12,13,14, 15,我们将其定义为传统的 cls。然而, 由于交感神经干和输尿管的位置都在前筋膜前面, 失活剂可能会扩散到输尿管, 造成损伤。在显示影像学图像12、13、14、15的输尿管损伤报告中, 根据对比扩散情况, 药物被注射到前筋膜前。
根据我们以前执行 cls 程序的经验, 我们发现, 与针对交感神经主干相比, 瞄准灰色的 rami 通信器是非常有效和安全的。灰色 rami 通信是位于交感神经主干后面和在腰椎神经根前面的神经节后交感神经纤维, 沿着椎体的外侧边缘运行, 主要在腰大肌内。因此, 前筋膜为输尿管区提供了良好的屏障, 而腰肌为腰神经根提供了良好的屏障。我们将此过程定义为选择性 cls, 并在本协议中描述了选择性 cls 的技术细节。

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		<col />
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	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">0.9% Saline solution</td>
			<td style="width:247px;">Chinese Dazhong Pharmaceutical Co.,Ltd.</td>
			<td style="width:127px;">8F84D7</td>
			<td style="width:559px;">10 mL &#8569;2</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">10-cm 9# puncture needle</td>
			<td style="width:247px;">Peking University Third Hospital</td>
			<td style="width:127px;">Not Applicable</td>
			<td>7# for children</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">2% Lidocaine Hydrochloride Injection solution</td>
			<td style="width:247px;">Hubei Tiansheng Pharmaceutical Co.,Ltd.</td>
			<td style="width:127px;">20180434</td>
			<td>5 mL &#8569;2</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">5% Phenol diluted in aqueous solution</td>
			<td style="width:247px;">Peking University Third Hospital</td>
			<td style="width:127px;">Not Applicable</td>
			<td>10 mL</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Angiography system &#65288;DSA&#65289;</td>
			<td style="width:247px;">Philips</td>
			<td style="width:127px;">FD20</td>
			<td style="width:559px;">have X-ray fluoroscopy function</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Aseptic puncture kit</td>
			<td style="width:247px;">Peking University Third Hospital</td>
			<td style="width:127px;">Not Applicable</td>
			<td>6 pieces of surgical towel, gauze, cotton balls, blood vessel forceps, etc.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Contrast media&#65288;iodixanol injection; 320&#65289;</td>
			<td style="width:247px;">GE Healthcare</td>
			<td style="width:127px;">14160155</td>
			<td>320 mg I/mL</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Infrared frontal thermometer&#160;</td>
			<td style="width:247px;">OMRON health care (China) Co.,Ltd.</td>
			<td style="width:127px;">MC-720</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Iodophors skin disinfectants&#160;</td>
			<td style="width:247px;">Shanghai Likang Disinfectant Hi-Tech Co., Ltd.</td>
			<td style="width:127px;">20180404</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Sterile surgical gloves</td>
			<td style="width:247px;">Beijing Ruijing Latex products Co., Ltd.&#160;</td>
			<td style="width:127px;">2018070352</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Syringes and needles 10 mL</td>
			<td style="width:247px;">Shandong Weigao Group Medical Plolymer Co.,Ltd.</td>
			<td style="width:127px;">20180711</td>
			<td>10 mL &#8569;2</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Syringes and needles 5 mL</td>
			<td style="width:247px;">Shandong Weigao Group Medical Plolymer Co.,Ltd.</td>
			<td style="width:127px;">20180721</td>
			<td>5 mL &#8569;1</td>
		</tr>
	</tbody>
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targeting gray rami communicantes in selective chemical lumbar sympathectomy

化学腰椎交感神经切除术 (cls) 是一种常用的微创手术, 用于治疗包括下肢缺血性疾病、多汗症等在内的疾病。通常练习将穿刺针尖放置在腰大肌前筋膜前, 并在交感神经干周围注射激活剂, 这就是传统的 cls。输尿管损伤虽然比较罕见, 但却是常规 cls 最常见的并发症, 可对患者造成严重伤害。我们发现, 在前筋膜后面注射灭活剂, 只针对灰拉米通病, 有助于在血管扩张、汗液减少和止痛方面达到治疗效果, 与传统的 cls 相当, 而且很严重。并发症在很大程度上得到了减少。我们将此过程定义为选择性 cls。在这里, 我们提出了一个选择性 cls 协议。精确的针道和准确的评估的传播造影剂是至关重要的, 以确保药物注射后的前筋膜的前筋膜的腰大肌肉。针尖大约是腰椎 x 线外侧视图中椎体分界线的三分之一。对比主要局限在针尖周围, 沿腰肌纤维向外和向下扩散。这样, 前筋膜为输尿管区提供了天然屏障, 而腰肌为腰神经根提供了天然屏障。本文有几个亮点, 包括 1) 选择性 cls 过程的详细描述, 2) 对实施选择性 cls 的解剖基础的解释, 3) 选择性 cls 和传统的 cls。

针尖应处于最佳区域, 如图 1所示。在选择性 cls 中, 对比度被注射在腰大肌的前筋膜后面, 针对的是灰色的拉米通道。图 2显示了选择性 cls (a) 和传统 cls (b) 中对比度分布的比较。
预期的临床效果是血管扩张 (用于治疗雷诺氏综合征、生活网状、血栓闭塞性血管炎、缺血性糖尿病足和...

Watch this Scientific Journal Video about Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy at JoVE.com

Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy

我们提出了一个选择性化学腰椎交感神经切除术 (cls) 的方案, 它只停用灰色的拉米沟通, 而不是交感神经的躯干。选择性 cls 可帮助实现治疗效果的血管扩张, 汗液减少, 疼痛缓解, 可与传统的 cls, 严重的并发症, 特别是输尿管损伤, 可以减少。

选择性化学腰椎交感神经切除术中灰色拉米关节的靶向性

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the ...

Ureteropelvic损伤是传统化学腰椎切除术或CLS中最常见的严重并发症。虽然比较罕见，但对患者危害很大。该协议有助于精确传递psoas主要肌肉前筋膜背后的激活剂，允许选择性地瞄准灰色拉米通信，从而可以在很大程度上提高CLS的安全性。在开始治疗程序之前，根据患者的临床和实验室结果确认存在适应症和缺乏禁忌症。在计划内针穿刺地点用2%的针刺点两次消毒约30厘米的皮肤区域，用手术毛巾覆盖患者的背部。使用侧胸镜检查指导，麻醉皮肤和整个针道与5-8毫升0.5%利多卡因没有血管收缩剂，推进针逐渐到椎体表面。使用侧视图腰 X 射线将针尖定位在最佳注射区域。然后，注射0.5毫升的对比剂，以确认针尖是后侧筋膜的psoas肌肉。如果对比剂仍然主要局限于最佳区域，沿着psoas主要肌肉扩散，针头放置成功。将2毫升5%水性酚溶液注射到注射部位，调整针尖方向，确保1毫升酚扩散到患者头部，1毫升向患者头部扩散。注射苯酚后，从皮肤上取针，用纱布压缩并覆盖穿刺点，以达到血侧反应。注射后5分钟，确认满意的同情中断，皮肤温度至少上升2摄氏度。如果未实现令人满意的中断，则在一天内对总酚体积不超过 10 毫升的另一个最佳区域进行补充注射。再次测量患者的皮肤温度，计算小腿、植物和后脚温度升高的平均值。在注射酚溶液之前，确认针尖位于最佳区域。在选择性CLS中，对比剂被注射在psoas主要肌肉的前部筋膜后面，针对的是灰色的拉米交流剂。预期的临床效果是血管扩张、减少出汗和止痛。针尖的精确放置和对比剂扩散的评估对于确保在CLS治疗中准确定位灰色拉米通讯员至关重要。使用选择性 CLS，操作风险显著降低，因此 CLS 的指标可以扩大。

Research

JoVE Journal

Medicine

Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety

实时功能磁共振成像生物反馈，针对污染焦虑的眶额皮层

We present a method for training subjects to control activity in a region of their orbitofrontal cortex associated with contamination anxiety using ...

科研

医学

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

A Novel Method: Super-selective Adrenal Venous Sampling

一种新的方法: 超选择性肾上腺静脉取样

Primary aldosteronism (PA) and subclinical Cushing&#39;s syndrome (SCS) are conditions in which the adrenal glands autonomously produce excessive amounts ...

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Ovine Lumbar椎间盘退变模型利用横向腹膜后位钻伤

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Mechanical Ventilation Boot Camp Curriculum

机械通气训练营课程

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

Setup and Execution Of the Blindfolded Code Training Exercise

盲民代码训练练习的设置和执行

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

Structured Motor Rehabilitation After Selective Nerve Transfers

选择性神经转移后的结构化运动康复

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

Using a Chemical Biopsy for Graft Quality Assessment

使用化学活检进行移植质量评估

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...