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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Use of the Posterior Lumbar Approach for Psoas Major Injection in Hip Flexor Spasticity
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Use of the Posterior Lumbar Approach for Psoas Major Injection in Hip Flexor Spasticity

机译：使用后腰椎方法在髋部屈肌痉挛中的PSOAS重大喷射方法

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Background: Hip flexor spasticity in patients with upper motor neuron syndrome of multiple etiologies has been managed with botulinum neurotoxin injections mainly targeting the "iliopsoas" muscle. A lumbar approach to target psoas major (PM) has been described; however, it has not been incorporated into clinical practice due to perceived risk of injury to surrounding structures. This study will investigate the feasibility and accuracy of ultrasound-guided (UG)-PM injection using a lumbar approach by assessing the intra/extramuscular injectate spread in cadaveric specimens. Methods: In eight lightly embalmed specimens, toluidine blue dye/saline was injected into PM using a UG-posterior lumbar approach. The posterior abdominal wall was exposed, and dye spread and surrounding structures digitized and modeled in 3D. The area and vertebral level of dye spread, distance of dye to the inferior vena cava (IVC), and abdominal aorta (AA) and dye spread to adjacent organs were quantified. Results: The models enabled visualization of the dye spread in 3D. Mean area of dye spread was 24.4 ± 2.8 cm2; most commonly between L2 and L4 vertebral levels. Mean distance of the dye to AA was 3.2 ± 1.2 cm and to IVC was 1.8 ± 0.4 cm. Dye spread remained intramuscular in all but one specimen. No dye spread occurred to any adjacent organs. Conclusions: The injection of PM using the UG-posterior lumbar approach was consistent and without spread to surrounding structures. This technique alone or in addition to the anterior approach is expected to have better clinical outcomes in the treatment of hip flexor spasticity. Further clinical studies are required.
机译：背景：多种病因的上运动神经元综合征患者的髋屈肌痉挛已通过主要针对“髂腰肌”的肉毒杆菌神经毒素注射来治疗。描述了一种腰大肌（PM）靶向入路；然而，由于感知到周围结构的损伤风险，它尚未被纳入临床实践。本研究将通过评估尸体标本中肌肉内/肌肉外注射液的扩散情况，探讨超声引导（UG）-腰椎入路注射PM的可行性和准确性。方法：在八个轻度防腐的标本中，使用UG后腰入路将甲苯胺蓝染料/生理盐水注射到PM中。暴露后腹壁，染料扩散和周围结构数字化并在3D中建模。量化染料扩散的面积和椎体水平、染料到下腔静脉（IVC）和腹主动脉（AA）的距离以及染料到邻近器官的扩散。结果：这些模型能够在3D中显示染料扩散。染色扩散的平均面积为24.4±2.8 cm2；最常见于L2和L4椎体之间。染料到AA的平均距离为3.2±1.2厘米，到IVC的平均距离为1.8±0.4厘米。除了一个样本外，所有样本的染色扩散都保持在肌内。任何邻近器官均未出现染色扩散。结论：UG腰椎后入路注射PM是一致的，不会扩散到周围结构。在髋屈肌痉挛的治疗中，这种技术单独或加上前路手术有望获得更好的临床效果。需要进一步的临床研究。

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