坐骨神经阻滞广泛应用于下肢手术中的麻醉和术后镇痛,超声引导技术的应用使得坐骨神经及其周围解剖结构的可视化成为可能,从而显著提高了操作的精确性与安全性。了解坐骨神经的详细解剖特征对于选择合适的阻滞水平至关重要,因为该神经在下肢的走行跨越多个解剖区域,选择错误的入路可能导致麻醉不全或严重的并发症。此外,某些下肢手术,尤其是需要完全麻醉的清醒手术,可能需要对腰丛或其分支进行额外阻滞,以确保全身麻醉的效果。文章详细描述了坐骨神经及腰骶丛的主要解剖结构,并探讨了不同坐骨神经阻滞入路的临床适应症。通过分析四种不同解剖水平下的超声引导坐骨神经阻滞方法,总结了每种入路的操作技巧及其典型超声标志,帮助临床医生在阻滞过程中识别关键解剖结构,从而确保安全、有效地实施麻醉。同时,文章也强调了超声引导下的实时监控对于麻醉剂分布的精确控制,进一步提升了临床操作的成功率和患者的安全性。The sciatic nerve block is widely used for anesthesia and postoperative analgesia in lower limb surgeries, and the application of ultrasound guidance allows for visualization of the sciatic nerve and its surrounding anatomical structures, significantly improving the accuracy and safety of the procedure. Understanding the detailed anatomy of the sciatic nerve is crucial for selecting the appropriate level of block, as the nerve traverses multiple anatomical regions in the lower limb. Incorrect choice of block approach may lead to inadequate anesthesia or serious complications. Furthermore, some lower limb surgeries, particularly awake surgeries requiring complete anesthesia, may necessitate additional blockade of the lumbar plexus or its branches to ensure comprehensive anesthetic effects. This article provides a detailed description of the main anatomical structures of the sciatic nerve and lumbosacral plexus and
坐骨神经痛是一种临床中常见的神经病理性疼痛,表现为以坐骨神经径路烧灼样、刀割样疼痛及麻木等症状,对患者的日常生活、正常工作、心理都造成了很大的影响。在中医保守治疗中,推拿是治疗经筋损伤、神经疼痛的主要手段,其作用机理在于改善局部血供、缓解肌肉筋挛、减轻对神经的压迫;具有活血化瘀、松解黏连、疏通经络、缓解神经痛的作用。推拿还有费用低,不良反应少,疗效显著等特点,在临床上广受欢迎。在经筋理论的指导下,医者可选择拔伸类、松解类、斜扳类3大类手法给与患者治疗,此外,推拿手法还可结合针灸、中药及电针一起使用,往往可取得满意疗效。Sciatica is a common neuropathic pain in clinical practice, manifested as sciatic nerve path burning, knife cut pain and numbness, and other symptoms, which have a great impact on patients’ daily life, normal work and psychology. In the conservative treatment of traditional Chinese medicine, massage is the main means to treat tendon injury and nerve pain. Its mechanism of action is to improve local blood supply, relieve muscle clonus and reduce the pressure on nerves;It has the effect of activating blood circulation and removing blood stasis, releasing adhesion, dredging meridians and relieving neuralgia. Massage also has the characteristics of low cost, less adverse reactions and significant curative effect, which is widely popular in clinical practice. Under the guidance of the theory of tendons, doctors can choose to give patients with three major categories of manipulation, such as pulling, loosening and oblique manipulation. In addition, massage manipulation can also be used together with acupuncture, traditional Chinese medicine and electro-acupuncture, which can often achieve satisfactory results.
