超声波在胸腔内侧支阻滞和胸腔冷却射频消融中的临床应用:病例报告和文献综述。

IF 0.8 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Ultrasound Pub Date : 2024-09-18 DOI:10.1177/1742271X241275242
Kevin J Yang, Porus D Mistry, William F Spalding
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引用次数: 0

摘要

简介射频消融术是一种通过射频产生的热量破坏神经来缓解疼痛的手术。传统上,射频消融术前要先进行诊断性内侧支阻滞注射,两者均由透视引导。由于解剖学上的复杂性,透视胸椎横突的上外侧(胸腔内侧支神经的发源地)可能具有挑战性,尤其是肥胖患者。我们介绍了一种新技术,即在透视的同时利用超声波对胸腔内侧支神经进行内侧支阻滞和射频消融:病例报告:首先,在超声引导下进行了两次诊断性胸内侧支神经阻滞。病例报告:首先,在超声波引导下进行了两次诊断性胸内侧支神经阻滞,然后在超声波引导下将脊髓针推进到目标胸内侧支神经处进行射频消融。然后在透视图的引导下,根据这些脊髓针的位置放置冷却的射频消融探针。患者在手术后的疼痛缓解率达到 100%:讨论:我们发现,超声波的加入使我们克服了仅在透视下观察胸椎横突上外侧的难题。超声直视使我们能够在透视解剖不佳的患者身上准确、安全地实施胸腔内侧支阻滞和射频消融术,患者在内侧支阻滞和射频消融术后疼痛完全缓解就证明了这一点。我们还推测,我们的新技术可以让医疗人员直接观察胸膜,从而降低胸腔内侧支阻滞和冷却射频消融术引起严重气胸的风险。
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Clinical application of ultrasound in thoracic medial branch block and thoracic cooled-radiofrequency ablation: Case report and literature review.

Introduction: Radiofrequency ablation is a procedure used to alleviate pain by destroying nerves with by radiofrequency-generated heat. Traditionally, radiofrequency ablation is preceded by diagnostic medial branch block injections, both guided by fluoroscopy. Fluoroscopic visualization of the superolateral aspect of the thoracic transverse process, where thoracic medial branch nerves occur, can be challenging due to anatomical complexities, especially in obese patients. We present a novel technique in which ultrasound was utilized in conjunction with fluoroscopy to perform medial branch block and radiofrequency ablation of the thoracic medial branch nerves.

Case report: First, two diagnostic thoracic medial branch nerve blocks were performed under ultrasound guidance. For the subsequent radiofrequency ablation, spinal needles were first advanced under ultrasound guidance to the target thoracic medial branch nerves. The position of those spinal needles was then used to guide the placement of cooled radiofrequency ablation probes using fluoroscopy. The patient reported 100% pain relief following the procedures.

Discussion: We found that the addition of ultrasound allowed us to overcome the challenge of visualizing the superolateral aspect of thoracic transverse process under fluoroscopy alone. Direct ultrasound visualization allowed us to accurately and safely perform a thoracic medial branch block and radiofrequency ablation in a patient with poor fluoroscopic anatomy, as demonstrated by the patient's complete pain relief after both medial branch block and radiofrequency ablation. We also theorize that our novel technique allows the provider to directly visualize the pleura, which could reduce the risk of severe pneumothorax associated with thoracic medial branch block and cooled radiofrequency ablation.

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来源期刊
Ultrasound
Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍: Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.
期刊最新文献
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