| Objective: To observe the anterior thoracolumbar sacral meningovertebral ligament and the dura mater connected to it in 6 children’s cadaver specimens,and to explore the possible anatomical reasons of rare but abnormally serious complications of epidural anesthesia which is block spinal nerves abnormally widely,as much as possible provide an anatomical reference for clinical anesthesiologists to provide guidance for further research.Method: The six cadaveric specimens of complete pediatrics were selected from the anatomy laboratory of Medical University.The age is 3-6 years old,including 4 males and 2 females.In addition,in order to facilitate the observation of the structure of the dorsal meningovertebral ligament of the dorsum and the dura mater connected to catheter,we preliminarily dissected an adult40-year-old male specimen.Anatomical methods are for the comprehensive pre-experiment and a lot of literature searches.First,from the dorsal approach,we routinely dissected the paraspinal muscles from 6 selected pediatric cadaver specimens,and freed excess muscle tissue to obtain the cervical spine and thoracic spine specimens.Secondly,the spine is traversed from the spinous process of C7-T1,and the ribs connected to both sides of the thoracic vertebrae are descended downward,and the tibia on both sides of the saw off remains the appendix bone,and the spine specimen is completely removed.Thirdly,from the ventral approach,using the medical pendulum saw to cut the pedicle from both sides of the T1-S5 segment,taking care to avoid the connection between the dura mater and the posterior wall of the spinal canal;observe the dorsal meningovertebral ligament and its the structure was connected,and the distribution of the vertebral ligaments of the 6 pediatric cadaver specimens at different levels of the spine and the vertebral or flavum ligamentum flavum was described and summarized.After then,the epidural space,the dura mater,the subdural space,arachnoid and other layers was exposed using tweezers and the dorsum of the pediatric specimens wasmeasured at different levels of the spine.The median of the 3 measurements is resulting in a range of changes in the dural thickness of the segment for subsequent reference.The resulting reference range is compared to the adult dorsal dural thickness at different segmental levels of the spine.Results It was found in the corpse specimens of children that many fibrous structures connected to the dura mater at the other end and the lamina or the flavum ligamentum at the other end were the vertebral ligaments to be studied.At the different segments of the spine,the distribution of the dorsal meningovertebral ligament of the pediatric cadaver specimens with the vertebral body or the flavum ligamentum was as follows:the incidence rate in the thoracic segment was 63.19%;the incidence in the lumbar segment was 88.33%;the rate of occurrence is 100%.The incidence rate of the posterior vertebral ligament in the thoracic lamina was 44.44% in the pediatric cadaver specimens;81.94% in the thoracic flavum ligamentum;86.67% in the lumbar lamina;the incidence of the flavum ligamentum in the lumbar region 90%.The thickness of the adult dura mater varies from section to segment,with the thickest occipital region(2-2.5mm),the neck and thoracic segments(1.5mm and 1.0mm,respectively),and the lumbar segment(again,0.33-0.66mm).The thinnest section(about 0.2 mm),the thickness of the dura mater from the neck to the lumbosacral region is getting thinner and thinner.Therefore,it is speculated that there should be similar thickness changes in the dorsal dorsal cerebral ventricle in children,and the dorsal dural thickness of the corpse in the different segments of the spine measured by the experiment is 0.20-0.40 mm in the thoracic segment and 0.15-0.35 mm in the lumbar segment.The section is 0.10-0.20 mm.Overall,the pediatric dura mater is thinner and the lumbosacral segment is thinner and easier to tear.Therefore,in children,in the process of epidural catheterization,it may be easier to tear the dorsal meningovertebral ligament ligament and damage the connected dura mater.When a conventional experimental dose of local anesthetic is injected,it enters the subdural space under direct diffusion and capillary effect,resulting in abnormally broad blockage.Therefore,in clinical anesthesia work,pediatric epidural anesthesia must be carefully and carefully puncture,should be divided into small,epidural administration.When the epidural puncture tube has resistance,the direction of the tube should be adjusted in time,or the tube should be re-punctured to avoid the above situation asmuch as possible.In this experiment,we can dissect and separate the subdural space on all corpse specimens of children(as shown in Figure 15,b,c it is the subdural space).Conclusions In the spinal canal of pediatric cadaver specimens,there are many dense vertebral ligaments,and the ligaments are thicker in the lumbosacral section.The dorsal spinal ganglia of children’s cadaveric spinal cord are thinner than adults.In other words,the distribution of the dorsal meningovertebral ligament in children and the weak dorsal dorsal ventricle may be an anatomical factor for subdural space block. |
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