摘要目的:探究超声引导下短轴与长轴切面引导技术在短颈患者颈脊神经后内侧支穿刺技术中的应用效果。方法:本研究为随机对照研究，选取2019年1月至2022年1月于延边大学附属医院疼痛科确诊为颈脊神经后支源性疼痛的短颈患者68例，男30例，女38例，年龄(46.1±8.1)岁，年龄范围为30~65岁。采用随机数表法将患者随机分为长轴组与短轴组，每组34例。短轴组患者在超声探头短轴切面引导下行颈脊神经后内侧支穿刺，长轴组患者在超声探头长轴切面引导下进行颈脊神经后内侧支穿刺。比较两组患者治疗前后数字评价量表评分(NRS)、第1次穿刺成功率、穿刺失败率、穿刺时间、满意度、穿刺靶点暴露率及穿刺相关并发症。结果:短轴组患者第1次穿刺成功率[85.3%(29/34)]高于长轴组[55.9%(19/34)]，穿刺时间[(15.2±1.7)s]少于长轴组[(35.1±2.7)s]，穿刺失败率[5.9%(2/34)]低于长轴组[23.5%(8/34)]，差异有统计学意义( P<0.05)。长轴组及短轴组穿刺成功患者在治疗后第1天[(4.2±0.2)分、(3.1±0.2)分]、第3天[(3.9±0.4)分、(2.6±0.3)分]、第5天[(3.6±0.2)分、(2.1±0.4)分]、第7天的NRS[(3.5±0.3)分、(2.0±0.4)分]均低于治疗前[(6.0±0.8)分、(6.1±1.1)分]，短轴组NRS均低于长轴组，差异有统计学意义( P<0.05)。长轴组患者C 3、C 4、C 5、C 6、C 7脊神经后内侧支靶点及总体的暴露率为28.6%(2/7)、82.4%(14/17)、90.0%(18/20)、73.7%(14/19)、33.3%(1/3)、74.2%(49/66)；短轴组患者C 3、C 4、C 5、C 6、C 7脊神经后内侧支靶点及总体的暴露率为83.3%(5/6)、93.8%(15/16)、95.5%(21/22)、95.0%(19/20)、100%(3/3)、94.0%(63/67)。短轴组患者C 3、C 4、C 5、C 6、C 7脊神经后内侧支靶点暴露率均高于长轴组，总体暴露率显著高于长轴组，差异有统计学意义( P<0.05)。短轴组患者的满意度高于长轴组，差异有统计学意义( P<0.05)。短轴组患者并发症发生情况[0%(0/34)]与长轴组患者[5.8%(2/34)]比较，差异有统计学意义( P<0.05)。 结论:超声下短轴切面法颈脊神经后内侧支穿刺更适合应用于短颈患者，可明显缩短穿刺时间，提高穿刺成功率、靶点暴露率及患者满意度。

abstractsObjective:To compare the application effects of ultrasound guidance short axial and long axial incision guidance technique in cervical spinal nerve in patients with short neck.Methods:This study was a randomized controlled study, selected 68 patients with short neck diagnosed with posterior cervical spinal nerve branched pain in the department of Painology of Yanbian University Affiliated Hospital from January 2019 to January 2022, there were 30 males and 38 females, age(46.1±8.1)years old, ranging form 30 to 65 years old.The patients were randomly divided into long axis group and short axis group, with 34 patients in each group.Patients in the short axis group was subjected to posterior medial branch puncture of the cervical spinal nerve under the ultrasound guidance with short axial, and the patients were subjected to posterior medial branch puncture of the cervical spinal nerve under the ultrasound guidance with long axial.The numerical rating scale(NRS), first puncture success rate, puncture failure rate, puncture time, satisfaction, puncture target exposure rate and puncture related complications before and after treatment of both two groups was compared.Results:The success rate of the first puncture in the short axis group [85.3%(29/34)] was significantly higher than that in the long axis group [55.9%(19/34)], the puncture time [(15.2±1.7)s] was significantly less than that of the long axis group [(35.1±2.7)s], and the puncture failure rate [5.9%(2/34)] was lower than that of the long axis group [23.5%(8/34)], the differences were statistically significant( P<0.05). The NRS scores of both two groups were lower at the first day[(4.2±0.2)points, (3.1±0.2)points], third days [(3.9±0.4)points, (2.6±0.3) points], fifth days[(3.6±0.2)points, (2.1±0.4)points] and seventh days[(4.2±0.2)points, (3.1±0.2)points] after treatment than those before treatment[(6.0±0.8)points, (6.1±1.1)points], the differences were statistically significant( P<0.05). The NRS of the short axis group was lower than that of the long axis group, the difference was statistically significant( P<0.05). In the long axis group, the overall exposure rate of the posterior medial spinal nerve targets of C 3, C 4, C 5, C 6, C 7 were 28.6%(2/7), 82.4%(14/17), 90.0%(18 /20), 73.7%(14/19), 33.3%(1/3), 74.2%(49/66), in the short axis, C 3, C 4, C 5, C 6, C 7 spinal patients were 83.3%(5/6), 93.8%(15/16), 95.5%(21/22), 95.0%(19/20), 100%(3/3), 94.0%(63/67). In the short axis group, the posterior medial branch target exposure rate of the C 3, C 4, C 5, C 6, C 7 spinal nerve patients were higher than that of the long axis group, and the overall exposure rate was significantly higher than that of the long axis group, the differences were statistically significant( P<0.05). Patient satisfaction in the short axis group was higher than that in the long axis group, the difference was statistically significant( P<0.05). Complications of patients in the short axis group [0%(0/34)] and [5.8%(2/34)] in the long axis group, the difference was statistically significant( P<0.05). Conclusions:Posteromedial branch puncture of cervical spinal nerve under the ultrasound guidance with short axial is more suitable for patients with short neck, which can significantly shorten the puncture time, improve the success rate of puncture, target exposure rate and patient satisfaction.