소아 환자에서 척수 자기공명영상을 이용한 요추천자 깊이의 예측
Determination of Needle Depth for Lumbar Puncture in Children Using Spine Magnetic Resonance Imaging
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Purpose : This study was performed to find the applicable equations which determine the proper needle depth for lumbar puncture in Korean pediatric patients using spine magnetic resonance imaging(MRI). Methods : The authors enrolled the patients who had spine MRI from August 2007 to June 2008 and were aged less than 20 years. Eighty eight patients whose height(Ht.) and weight(Wt.) were recorded within 10 days from spine MRI were recruited. The posterior dural depths and dural widths were measured on each L2-3, L3-4, and L4-5 levels of intervertebral space. By comparing the R squares, the most significant independent variables for posterior dural depth were selected, and by calculating malposition rate, the further insertion distance from posterior dural depth and the final puncture depth equation were determined. Results : The proper puncture depths with the lowest malposition rate were as follows. L2-3 puncture depth (mm) = 126.5×Wt./Ht. (kg/cm)＋7.1 or 0.613×Wt. (kg)＋16.1 L3-4 puncture depth (mm) = 136.0×Wt./Ht. (kg/cm)＋7.6 or 0.656×Wt. (kg)＋17.3 L4-5 puncture depth (mm) = 138.3×Wt./Ht. (kg/cm)＋7.5 or 0.665×Wt. (kg)＋17.5 Conclusion : Lumbar puncture depth is best predicted using weight and height as independent variables. And the equations of each tap sites were different in constants. Using this formula, the rate of failure and complication in lumbar can be diminished, but it should be validated by further studies.
Abstract
Purpose : This study was performed to find the applicable equations which determine the proper needle depth for lumbar puncture in Korean pediatric patients using spine magnetic resonance imaging(MRI). Methods : The authors enrolled the patients who had spine MRI from August 2007 to June 2008 and were aged less than 20 years. Eighty eight patients whose height(Ht.) and weight(Wt.) were recorded within 10 days from spine MRI were recruited. The posterior dural depths and dural widths were measured on each L2-3, L3-4, and L4-5 levels of intervertebral space. By comparing the R squares, the most significant independent variables for posterior dural depth were selected, and by calculating malposition rate, the further insertion distance from posterior dural depth and the final puncture depth equation were determined. Results : The proper puncture depths with the lowest malposition rate were as follows. L2-3 puncture depth (mm) = 126.5×Wt./Ht. (kg/cm)＋7.1 or 0.613×Wt. (kg)＋16.1 L3-4 puncture depth (mm) = 136.0×Wt./Ht. (kg/cm)＋7.6 or 0.656×Wt. (kg)＋17.3 L4-5 puncture depth (mm) = 138.3×Wt./Ht. (kg/cm)＋7.5 or 0.665×Wt. (kg)＋17.5 Conclusion : Lumbar puncture depth is best predicted using weight and height as independent variables. And the equations of each tap sites were different in constants. Using this formula, the rate of failure and complication in lumbar can be diminished, but it should be validated by further studies.
참고문헌 (23)
- Fletcher J.J., "Cerebrospinal Fluid and Intracranial Pressure, In Textbook of Clinical Neurology. 3 ed", pp.535~538 (2007), Saun-ders
- Michelson D.J., "Spinal Fluid Examination, In Pediatric Neurology: Principles & Practice. 4 ed", pp.156~159 (2006), Mosby
- Batnitzky S., "Campbell RL. Iatrogenic intraspinal epidermoid tumors", Jama, 237, pp.148~150 (1977)
- McDonald J.V., "Intraspinal epidermoid tumors caused by lumbar puncture", Arch Neurol, 43, pp.936~939 (1986)
- Rennick G., "Cerebral herniation during bacterial meningitis in children", Bmj, 306, pp.953~955 (1993)
- Benoist M., "Natural history of the aging spine", Eur Spine J, 12(Suppl 2), pp.S86~S89 (2003)
- AL. M., "Interpretation of traumatic lumbar puncture", Clinical Pediatrics, 225, pp.523~526 (1986)
- Abe K.K., "Lumbar puncture needle length determination", Am J Emerg Med, 23, pp.742~746 (2005)
- Bonadio W.A., "Estimating lumbar-puncture depth in children", N Engl J Med, 319, pp.952~953 (1988)
- Bosenberg A.T., "Skin-epidural distance in children", Anaesthesia, 50, pp.895~897 (1995)
- Craig F., "Depth of insertion of a lumbar puncture needle", Arch Dis Child, 77, pp.450~ (1997)
- Hasan M.A., "Depth of epidural space in children", Anaesthesia, 49, pp.1085~1087 (1994)
- Preusser A., "An attempt at a mathematical prediction of the depth of insertion of the needle in peridural anesthesia", Anaesthesiol Reanim, 16, pp.108~116 (1991)
- The Committee for pediatric growth standards, "Body mass index percentiles In : Korean National Growth Charts", 24~27 (2007)
- Pinheiro J.M., "Role of local anesthesia during lumbar puncture in neonates", Pediatrics, 91, pp.379~382 (1993)
- Carraccio C., "Lidocaine for lumbar punctures. A help not a hindrance", Arch Pediatr Adolesc Med, 150, pp.1044~1046 (1996)
- Schreiner R.L, "Incidence and effect of traumatic lumbar puncture in the neonate", Dev Med Child Neurol, 21, pp.483~487 (1979)
- Nigrovic L.E, "Risk factors for traumatic or unsuccessful lumbar punctures in children", Ann Emerg Med, 49, pp.762~771 (2007)
- Kil H.K., "Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children", Reg Anesth Pain Med, 32, pp.102~106 (2007)
- Inamasu J., "Ossification of the posterior longitudinal ligament: an update on its biology, epidemiology, and natural history", Neurosurgery, 58, pp.1027~1039 (2006)
- Hogan Q.H, "Epidural anatomy: new observations", Can J Anaesth, 45 (1998)
- Eknoyan G., "Adolphe Quetelet (1796-1874)-the average man and indices of obesity", Nephrol Dial Transplant, 23, pp.47~51 (2008)
- Sahebkar-Moghaddam F, "The failed lumbar puncture", Neurology, 64 (2005)