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股神经周围筋膜及其毗邻结构的解剖
Anatomy of the femoral fascia sheath and its adjacent structures
目的 探讨股神经周围是否存在完整的筋膜鞘以及股神经与周围筋膜的解剖学关系，为下肢外周神经阻滞麻醉的选择提供形态学依据。方
法选择5具10%福尔马林固定的两侧第1腰椎至大腿中段保存完整的标本进行研究，共10侧；其中8侧由远端向近端逐步注射乳胶后局部解剖观察，
1具标本即2侧经-35℃冷冻1周后制成横断面连续断层切片，行断层解剖观察。结果 本实验未发现股神经周围存在完整筋膜鞘。股神经周围有筋膜
样结构包绕，从近端向远端主要包括腰丛筋膜、腰大肌肌间隔、髂筋膜及疏松的脂肪组织。结论 大体解剖学观察股神经周围并不存在完整筋膜
鞘。
Objective To determine if a femoral nerve “sheath” exists and provide anatomic basis for the lower limb nerve
block. Methods Ten sides of lumbar and thigh regions from 5 formalin-fixed cadavers were used in this study. Eight out of 10
specimens were injected with latex using a step-by-step injection method from the distal to the proximal and dissected for
topographic anatomy examination. The other two sides from the same body were deep frozen at -35℃ for a week, cut with a bandsaw
and used for sectional anatomy examination. Results An intact femoral nerve “fascial sheath” was not observed in the specimens
examined in this study. The nerve was surrounded by various fascia-like structures. From the proximal to the distal, those
fascia-like structures were the fascia of lumbar plexus, fascial septum of the psoas, the iliac fascia and loose connective
tissue covering the femoral nerve. Conclusion At the gross anatomy level, an intact femoral nerve “fascial sheath” may not exist.
股神经 / 筋膜 / “3合1”阻滞 / 髂筋膜阻滞 / 解剖 / 人
Femoral nerve / Fascia / “3-in-1”block / Iliac fascia block / Anatomy / Human
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［2］McMeniman TJ, McMeniman PJ, Myers PT, et al. Femoral nerve block vs fascia iliaca block for total knee arthroplasty postoperative pain control: a prospective, randomized controlled trial［J］. J Jarthroplasty, 2010,25(8):1246-1249.
［3］Wang XL, Zhang DZh, Wang G. The observation of fascia iliaca block combined with general anesthesia for the surgey of pediatric hip dislocation［J］. The Journal of Clinical Anesthesiology, 2010, 26(8):711-712.(in Chinese)
王晓林,张大志,王庚.髂筋膜阻滞复合全身麻醉用于小儿髋脱位手术的观察［J］.临床麻醉学杂志,2010, 26(8):711-712.
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［6］Farid IS, Heiner EJ, Fleissner PR. Comparison of femoral nerve block and fascia iliaca block for analgesia following reconstructive knee surgery in adolescents［J］. J Clin Anesth, 2010, 22(4):256-259.
［7］Sharrock NE. Inadvertent “3-in-1” block following injection of the lateral cutaneous nerve of thigh［J］. Anesth Analg, 1980, 59(11):887-888.
［8］Lonsdale M. 3-in-1 block: confirmation of winnie’s anatomical hypothesis［J］. Anesth Analg, 1988, 67(6):601-602.
［9］Ritter JW. Femoral nerve “sheath” for inguinal paravascular lumbar plexus block is not found in human cadavers［J］. J Clin Anesth, 1995, 7(6):470-473.
［10］Nash L, Nicholson HD, Zhang M. Does the investing layer of the deep cervical fascia exist ［J］? Anesthesiology, 2005, 103(5):962-968.
［11］Honma M, Murakami G, Sato TJ, et al. Spread of injectate during C6 stellate ganglion block and fascial arrangement in the prevertebral region: an experimental study using donated cadavers［J］. Reg Anesth Pain Med, 2000, 25(6):573-583.
［12］[ZK(]Fang XW. Clinical study on the effect of fascia iliaca compartment block for post-hip arthroplasty［D］.Soochow University,2011:14-15. (in Chinese)
房小文.髋关节置换术后髂筋膜室阻滞镇痛效果观察［D］.苏州大学,2011:14-15.
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