肩中俞及大杼穴解剖学结构及安全针刺深度及角度.docVIP

肩中俞及大杼穴解剖学结构及安全针刺深度及角度 　 作者：谢永财, 陈跃, 吴炳煌, 张文光, 张家栋 【关键词】 穴,肩中俞;,穴,大杼;,解剖学;,针刺深度;,针刺方向 　　摘要: 目的 探讨肩中俞与大杼穴的解剖学结构与针刺深度、角度的关系。方法 经福尔马林固定的成年人尸体46具,男性30具,女性16具,采用钢针标定法和层次解剖法进行研究。结果 肩中俞向下直刺的解剖结构依次是皮肤、浅筋膜、斜方肌、菱形肌、颈夹肌、竖脊肌、胸膜上膜、胸膜顶;大杼穴向下直刺的解剖结构依次是皮肤、浅筋膜、斜方肌、菱形肌、上后锯肌、颈夹肌、竖脊肌、肋提肌、肋间内膜、肋胸膜。向下直刺的平均危险深度:肩中俞为60.60 mm,大杼穴为55.93 mm。结论 肩中俞和大杼穴向下直刺的深度应控制在lt;42 mm。 　　关键词: 穴,肩中俞; 穴,大杼; 解剖学; 针刺深度; 针刺方向 　　ABSTRACT:Objective To probe into the anatomic structure and safe needling depth and angle of “Jianzhongshu” and “Dazhu” point. Methods Fortysix adult corpses were selected. Among them, 30 were ma1e and 16 female. Layer anatomy method were used to study the anatomic structure and suitable needleinsertion depth. Results　The anatomic structures of “Jianzhongshu” for perpendicular insertion downward were skin, superficial fascia, trapezius, rhomboideus, splenius cervicis, erector spinae, suprapleural membrane and cupula of pleura in order.The anatomic structures of “Dazhu” were skin, superficial fascia, trapezius, rhomboideus, upper posterior serratus, splenius cervicis, erector spinae, levator ribs, internal intercostal membrane and costal pleura in order. The mean dangerous depth for perpendicular insertion downward was 60.60 mm of “Jianzhongshu” and 55.93 mm of “Dazhu”. Conclusion For safety, it is suggested that the depth for perpendicular needling of “Jianzhongshu” and “Dazhu” is within 42 mm in adult. 　　KEY WORDS: point SI15,Jianzhongshu; point BL11,Dazhu; anatomy; needling depth; needing direction 　　 　　肩中俞与大杼穴为肩背部的穴位,是针灸应用频率较高、疗效较好的腧穴。由于该穴位置的特殊性,临床医生在操作中若针刺角度及深度控制不当,容易引起针刺意外[13]。笔者对肩中俞与大杼穴的针刺安全深度及角度进行解剖学观测,以期为临床医师及科研人员提供肩中俞与大杼穴安全针刺的层次结构、深度及角度,避免针刺意外。 　　1 材料和方法 　　1.1 材料 　　46具经福尔马林固定的成年人尸体,男性30具(60侧),女性16具(32侧),共92侧。 　　1.2 方法 　　(1)解剖打开胸腔:先于胸骨角平面切开胸前壁至两侧腋前线附近,用咬骨钳离断胸骨和肋骨。沿两侧腋前线纵向打开胸前壁,暴露胸腔,切断肺根,取出双肺。(2)定穴及穿刺:根据《经穴部位标准》,肩中俞定位于“第七颈椎棘突下,旁开2寸”,大杼穴定位于“第一胸椎棘突下,旁开1.5寸”。模拟临床针灸进针,采用沾染墨汁的小号克氏针于肩中俞及大杼穴处穿刺,直至针头刚好刺破壁胸膜,并刺染穴位深处各层结构。(3)测量:用血管钳于皮肤处夹住克氏针拔出,采用分规、游标卡尺(精确度为0.01 mm)测量穿刺针皮肤至壁胸膜的距离,即该腧穴的危险深度