Trident sign positioning intertransverse ligament psoas block operation process system

Abstract

This invention discloses a system for locating the trident sign for psoas major muscle block of the intertransverse ligament, belonging to the field of medical anesthesia technology. It solves the technical problems of traditional psoas major muscle block procedures, such as inaccurate localization, reliance on experience, lack of objective indicators for efficacy verification, and lack of closed-loop feedback. The system comprises four modules: patient preparation and positioning, ultrasound scanning and trident sign localization, puncture and block administration, and efficacy evaluation. It uses the "trident sign" of the lumbar transverse processes as the basic localization landmark and the intertransverse ligament as the key puncture landmark. It employs in-plane puncture, tactile feedback, and real-time ultrasound imaging for dual verification to achieve precise needle tip localization. This invention achieves precise localization, standardized puncture, objective efficacy, and a systematic process for psoas major muscle block, reducing reliance on physician experience, achieving a success rate of ≥95%, significantly reducing the incidence of complications, and demonstrating strong repeatability. It is suitable for regional anesthesia and postoperative analgesia in clinical lumbar spine surgeries.

Description

Technical Field

[0001] This invention belongs to the field of lumbar plexus nerve block technology, and particularly relates to a trident sign-based system for locating and blocking the psoas major muscle of the intertransverse ligament. Background Technology

[0002] Psoas muscle block is a commonly used lumbar plexus nerve block technique in clinical practice. It is widely used in regional anesthesia and postoperative analgesia for lumbar spine-related surgeries such as lumbar fractures, lumbar disc herniation, and hip joint surgery. Its core is to accurately inject local anesthetic into the target space on the posterior border fascia of the psoas muscle to block the conduction of lumbar plexus nerve branches and achieve analgesia in the surgical area.

[0003] Traditional psoas muscle block procedures often rely on blind puncture using anatomical landmarks. Due to factors such as patient body size, anatomical variations, and fat thickness, the positioning accuracy is extremely poor. The needle tip is prone to accidentally entering blood vessels, nerve sheaths, or the abdominal cavity, which not only leads to poor blocking effects but also easily causes serious complications such as vascular damage, nerve damage, and local anesthetic poisoning. The success rate of the block is only 60%-70%.

[0004] With the application of ultrasound technology in the field of anesthesia, ultrasound-guided psoas muscle block has solved some of the problems of blind puncture, but existing ultrasound-guided methods still have obvious technical defects, specifically: Existing methods mostly rely on vague structures such as the psoas major muscle and lumbar transverse processes as localization references, lack specific acoustic landmarks, and are highly dependent on the ultrasound anatomy experience of the operating physician. The operation varies greatly among different physicians, making it difficult to form a standardized operating procedure. Relying solely on ultrasound imaging to verify the needle tip position, without the aid of tactile feedback, can easily lead to misjudgment of the needle tip position, resulting in the injection of local anesthetic into non-target spaces and uncontrolled diffusion of the drug solution.

[0005] Therefore, it is necessary to provide a new system for the trident sign-based intertransverse ligament psoas major muscle block procedure to solve the above-mentioned technical problems. Summary of the Invention

[0006] The technical problem solved by this invention is to provide a trident sign-based system for locating psoas major muscle block of the intertransverse ligament, which achieves precise positioning, standardized puncture, objective results, and systematic procedures, reduces reliance on physician experience, has a success rate of ≥95%, significantly reduces the incidence of complications, and is highly repeatable. It is suitable for regional anesthesia and postoperative analgesia in clinical lumbar spine-related surgeries.

[0007] To solve the above-mentioned technical problems, the present invention provides a trident sign localization intertransverse ligament psoas major muscle block operation procedure system, which includes a patient preparation and positioning module, an ultrasound scanning and trident sign localization module, a puncture and block implementation module, and an effect evaluation module that work in sequence and in concert. Using the "trident sign" under ultrasound imaging of the transverse processes of the lumbar spine as the basic positioning landmark and the intertransverse ligament as the key acoustic anatomical landmark for puncture, the system employs in-plane puncture technology combined with tactile feedback and real-time ultrasound imaging to achieve precise needle tip positioning. The system uses characteristic diffusion images of the drug solution to determine the immediate effect of the blockade, and then uses standardized acupuncture methods to verify the physiological effect of the blockade. The system constructs a closed-loop working logic of five nodes: judgment-feedback-correction. The five core judgment nodes are the trident sign recognition node, the intertransverse ligament recognition node, the ligament breakthrough double verification node, the drug solution diffusion characteristic node, and the blockade effect success judgment node. If any node fails to meet the standard, the corresponding correction operation is triggered. If the standard is still not met after correction, the operation is terminated and an abnormality analysis report is generated.

[0008] As a further aspect of the present invention, the ultrasound scanning and trident sign localization module uses a 2-5MHz convex array ultrasound probe, and performs scanning on a paramedian sagittal oblique section 3-4cm lateral to the spinous process. The probe is slid along the head-to-tail direction to identify the tips of the L1-L3 transverse processes. The accurate identification of the "trident sign" is achieved through the imaging features of the arc-shaped hyperechoic shadow and the posterior finger-like acoustic shadow. The module has a built-in anatomical structure recognition feedback mechanism. When the trident sign is not identified, a prompt for scanning parameter adjustment is triggered. The scanning parameter adjustment includes a ±5° fine adjustment of the probe section angle and an incremental adjustment of the distance lateral to the spinous process in 0.5cm increments.

[0009] As a further aspect of the present invention, the ultrasound scanning and trident sign localization module, based on the trident sign recognition, completes the identification of the intertransverse ligament by adjusting the probe angle ±5° and the probe pressure. The intertransverse ligament is a thin, linear, hyperechoic structure between the tips of adjacent transverse processes. The module simultaneously marks the potential gap on the surface of the fascia at the posterior border of the psoas major muscle deep to the ligament as the puncture target, and displays the depth of the target and the anatomical distance from the surrounding tissues in real time. The target depth monitoring accuracy is 0.1 cm.

[0010] As a further aspect of the present invention, the puncture and blockage implementation module uses a 22G blockage needle with a length of 80-100mm. The puncture path is planned to be 1-2cm from the tail side of the probe, with the needle inserted from the outer side to the inner side along the long axis of the probe. The needle path and the ultrasonic beam are kept coplanar. The module has a built-in needle insertion speed monitoring and needle path deviation warning mechanism. The needle insertion speed control threshold is 0.5cm / s. When the needle path deviates from the ultrasonic beam, an immediate audio-visual prompt is triggered.

[0011] As a further aspect of the present invention, the puncture and blockade implementation module constructs a dual-verification ligament breakthrough determination mechanism of ultrasound imaging + tactile feedback: when the strong echo point of the needle tip contacts the high echo line of the ligament under ultrasound, a resistance sensing prompt is triggered; when the needle tip penetrates the ligament and a feeling of sudden loss of resistance occurs, ultrasound simultaneously confirms that the strong echo point of the needle tip is located in the potential gap on the surface of the deep ligament and the posterior edge of the psoas major muscle fascia. When both signals are satisfied, it is determined that the puncture target has been met; when a single signal is satisfied, a needle tip position correction prompt is triggered.

[0012] As a further aspect of the present invention, after the target site is reached, the puncture and blockade implementation module executes the operation logic of aspirating without blood or fluid → slowly injecting the drug, with a reflux time of ≥5 seconds and an injection rate of 1mL / s, injecting 20-25mL of 0.3% ropivacaine; the module monitors the drug diffusion pattern in real time by ultrasound, and only when the drug exhibits crescent-shaped / fusiform diffusion, pushes the intertransverse ligament forward, and diffuses along the head-to-tail direction on the surface of the psoas major muscle, it is determined that the drug diffusion has reached the target.

[0013] As a further aspect of the present invention, the effect evaluation module is activated 10-15 minutes after the drug injection is completed. A sterile injection needle is used to perform acupuncture at a frequency of 1 time / second to sequentially test the skin innervation areas of the iliohypogastric nerve (T12-L1), ilioinguinal nerve (L1), lateral femoral cutaneous nerve (L2-L3), femoral nerve (L2-L4), and obturator nerve (L2-L4) on the affected side. The range of sensory reduction / loss is recorded by comparing with the healthy side. The module has a built-in algorithm for judging the success of the blockade. The blockade operation is judged to be successful only when sensory reduction / loss occurs in the innervation areas of both the femoral nerve and the lateral femoral cutaneous nerve.

[0014] As a further aspect of the present invention, the effect evaluation module also integrates extended functions such as motor blockade monitoring, anesthetic drug dosage statistics, postoperative analgesia effect tracking, and complication early warning; the motor blockade monitoring records the quadriceps muscle strength grade (0-5), the anesthetic drug dosage statistics have an accuracy of 0.1 mL, the postoperative analgesia VAS score (0-10) is tracked 72 hours later, and complications such as vascular injury, nerve injury, and local anesthetic poisoning are graded and warned in grades I-III.

[0015] As a further aspect of the present invention, the patient preparation and positioning module includes four sub-functions: preoperative visit, vital sign monitoring, positioning, and aseptic operation; the positioning is a lateral decubitus position with the affected side facing upward, hip and knee flexed at 90°, and the spine maintaining its natural physiological curvature; the aseptic operation uses iodine-soaked spiral disinfection with a disinfection area diameter ≥15cm, and a sterile drape is laid to expose the puncture area.

[0016] As a further aspect of the present invention, the system is operated by a physician with anesthesiology qualifications, the operating environment is a standard anesthesia operating room in a hospital, the sterility level of the supporting instruments is medical sterile, and the display resolution of the ultrasound image is ≥1024×768. To achieve the above-mentioned objectives, this invention provides a system for locating the trident sign and performing intertransverse ligament psoas muscle block, comprising a patient preparation and positioning module, an ultrasound scanning and trident sign location module, a puncture and block implementation module, and an effect evaluation module that work sequentially and collaboratively. Each module works collaboratively through data interaction. The system constructs a closed-loop working logic of five nodes: judgment, feedback, and correction. The specific technical solution is as follows: Patient preparation and positioning module: Complete preoperative visit, vital sign monitoring, standardized positioning, and aseptic operation in the puncture area to lay the foundation for subsequent operations; Ultrasound scanning and trident sign localization module: It uses a 2-5MHz convex array ultrasound probe to accurately identify the "trident sign" of the L1-L3 transverse processes, uses the intertransverse ligament as a key landmark to mark the puncture target, displays the anatomical parameters of the target in real time, and triggers parameter adjustment prompts when no characteristic structure is identified. Puncture and Block Implementation Module: Plans a standardized in-plane puncture path, uses a 22G blocking needle to achieve precise needle insertion, completes ligament breakthrough determination through dual verification of ultrasound imaging and tactile loss sensation, executes standardized drug injection operation, and achieves immediate effect determination by real-time monitoring of the characteristic diffusion pattern of the drug solution through ultrasound. Effect evaluation module: After the injection is completed, the standardized acupuncture method is activated to achieve objective evaluation of sensory blockade of lumbar plexus nerve branches. At the same time, it integrates extended functions such as motor blockade monitoring, drug dosage statistics, postoperative analgesia tracking, and complication early warning. Closed-loop feedback logic: Clear judgment criteria are set for five core nodes: ultrasound positioning, puncture and needle insertion, ligament breakthrough, drug injection, and effect evaluation. If any node fails to meet the criteria, the corresponding correction operation is triggered. If the criteria are still not met after correction, the operation is terminated and an abnormality cause analysis report is generated.

[0017] Compared with related technologies, the trident sign localization and intertransverse ligament psoas muscle block procedure system provided by the present invention has the following beneficial effects: This invention uses the "trident sign" (arc-shaped hyperechoic shadow + finger-like acoustic shadow) as a constant acoustic feature of the lumbar spine as a basic positioning landmark, combined with the intertransverse ligament as a key puncture landmark, to achieve precise positioning of the target space for psoas muscle block. This breaks through the bottleneck of existing technologies that rely on the physician's experience in ultrasound anatomy. Junior anesthesiologists in primary hospitals can complete the precise positioning after simple training, with a positioning error of ≤0.3cm. A standardized in-plane puncture path was constructed, with the needle inserted 1-2 cm from the tail of the probe and punctured from the posterolateral to the anteromedial aspect along the long axis of the probe. Combined with the dual verification ligament breakthrough mechanism of "ultrasound imaging + tactile sense of loss", the needle tip position was monitored in real time throughout the process to avoid the needle tip accidentally entering blood vessels, nerve sheaths or the abdominal cavity. This reduced the incidence of complications such as vascular injury, nerve injury and local anesthetic poisoning to less than 1%, greatly improving the safety of the operation. The characteristic images of the crescent-shaped / fusiform diffusion of the drug solution, pushing up the intertransverse ligament, and spreading along the head and tail of the psoas major muscle are used as immediate objective indicators of blockade. This allows for early determination of whether the needle tip position is correct, avoiding postoperative blockade failure. Combined with standardized acupuncture techniques, the physiological verification of lumbar plexus nerve branch sensory blockade is completed, doubly confirming the blockade effect and increasing the success rate of psoas major muscle blockade to over 95%. A standardized operating system for the entire process, from patient preparation to effect evaluation, has been established. A feedback-correction mechanism has been set up for five core judgment nodes. Each operation step has clear judgment criteria, operation parameters and correction schemes. The operation is highly repeatable and can be widely promoted in hospitals at all levels (especially primary hospitals), thus promoting the standardized development of clinical psoas muscle block technology. Attached Figure Description

[0018] To facilitate understanding by those skilled in the art, the present invention will be further described below with reference to the accompanying drawings.

[0019] Figure 1 The modular architecture diagram of the trident sign localization intertransverse ligament psoas major muscle block operation procedure system provided by the present invention. Figure 2 This is a schematic diagram of the trident sign of the transverse processes of the lumbar spine L1-L3 under ultrasound, as described in this invention. Figure 3 This is a schematic diagram of an ultrasound image of the intertransverse ligament and surrounding anatomical structures of the lumbar vertebrae according to the present invention.

[0020] Figure 4 This is a schematic diagram of the in-plane puncture path and needle tip positioning of the present invention using ultrasound imaging. Figure 5 This is a schematic diagram of the characteristic ultrasound image of drug diffusion in this invention. Detailed Implementation

[0021] Please refer to the following: Figure 1 and Figure 5 ,in, Figure 1 The modular architecture diagram of the trident sign localization intertransverse ligament psoas major muscle block operation procedure system provided by the present invention. Figure 2 This is a schematic diagram of the trident sign of the transverse processes of the lumbar spine L1-L3 under ultrasound, as described in this invention. Figure 3 This is a schematic diagram of an ultrasound image of the intertransverse ligament and surrounding anatomical structures of the lumbar vertebrae according to the present invention. Figure 4This is a schematic diagram of the in-plane puncture path and needle tip positioning of the present invention using ultrasound imaging. Figure 5 This is a schematic diagram of the characteristic ultrasound image of drug diffusion according to the present invention. The trident sign localization intertransverse ligament psoas major muscle block procedure system is characterized by comprising a patient preparation and positioning module, an ultrasound scanning and trident sign localization module, a puncture and block implementation module, and an effect evaluation module that work sequentially and in concert. Using the "trident sign" under ultrasound imaging of the transverse processes of the lumbar spine as the basic positioning landmark and the intertransverse ligament as the key acoustic anatomical landmark for puncture, the system employs in-plane puncture technology combined with tactile feedback and real-time ultrasound imaging to achieve precise needle tip positioning. The system uses characteristic diffusion images of the drug solution to determine the immediate effect of the blockade, and then uses standardized acupuncture methods to verify the physiological effect of the blockade. The system constructs a closed-loop working logic of five nodes: judgment-feedback-correction. The five core judgment nodes are the trident sign recognition node, the intertransverse ligament recognition node, the ligament breakthrough double verification node, the drug solution diffusion characteristic node, and the blockade effect success judgment node. If any node fails to meet the standard, the corresponding correction operation is triggered. If the standard is still not met after correction, the operation is terminated and an abnormality analysis report is generated.

[0022] The ultrasound scanning and trident sign localization module uses a 2-5MHz convex array ultrasound probe. It scans a parasagittal oblique section 3-4cm lateral to the spinous process and slides the probe along the head-to-tail direction to identify the tips of the L1-L3 transverse processes. The "trident sign" is accurately identified through the imaging features of the arc-shaped hyperechoic shadow and the posterior finger-like acoustic shadow. The module has a built-in anatomical structure recognition feedback mechanism. If the trident sign is not identified, it triggers a prompt to adjust the scanning parameters. The scanning parameter adjustment includes a ±5° fine adjustment of the probe section angle and an incremental adjustment of the distance lateral to the spinous process in 0.5cm increments.

[0023] Based on the trident sign recognition, the ultrasound scanning and trident sign localization module identifies the intertransverse ligament by adjusting the probe angle ±5° and the probe pressure. The intertransverse ligament is a thin, linear, hyperechoic structure between the tips of adjacent transverse processes. The module also marks the potential gap on the surface of the fascia at the posterior border of the psoas major muscle deep to the ligament as the puncture target and displays the depth of the target and the anatomical distance from the surrounding tissues in real time. The target depth monitoring accuracy is 0.1 cm.

[0024] The puncture and blockade implementation module uses a 22G blockade needle with a length of 80-100mm. It plans an in-plane puncture path with the needle inserted 1-2cm from the tail side of the probe and from the outer side to the inner side along the long axis of the probe. The needle path and the ultrasonic beam are kept coplanar. The module has a built-in needle insertion speed monitoring and needle path deviation warning mechanism. The needle insertion speed control threshold is 0.5cm / s. When the needle path deviates from the ultrasonic beam, an immediate audio-visual prompt is triggered.

[0025] The puncture and blockade implementation module constructs a dual-verification ligament breakthrough determination mechanism of ultrasound imaging + tactile feedback: when the strong echo point of the needle tip comes into contact with the high echo line of the ligament under ultrasound, a resistance sensing prompt is triggered. When the needle tip penetrates the ligament and a feeling of sudden loss of resistance occurs, ultrasound simultaneously confirms that the strong echo point of the needle tip is located in the potential gap on the surface of the fascia at the deep surface of the ligament and the posterior edge of the psoas major muscle. When both signals are satisfied, it is determined that the puncture target has been met. When a single signal is satisfied, a needle tip position correction prompt is triggered.

[0026] After the target site is reached, the puncture and blockade implementation module executes the operation logic of aspirating without blood or fluid → slowly injecting the drug. The aspiration time is ≥5 seconds, the injection rate is 1mL / s, and 20-25mL of 0.3% ropivacaine is injected. The module monitors the drug diffusion pattern in real time with ultrasound. The drug diffusion is considered to be up to standard only when the drug shows crescent-shaped / fusiform diffusion, pushes the intertransverse ligament forward, and diffuses along the head-to-tail direction on the surface of the psoas major muscle.

[0027] The efficacy evaluation module is activated 10-15 minutes after the injection is completed. Using a sterile injection needle, acupuncture is performed at a frequency of 1 time / second to sequentially test the skin innervation areas of the iliohypogastric nerve (T12-L1), ilioinguinal nerve (L1), lateral femoral cutaneous nerve (L2-L3), femoral nerve (L2-L4), and obturator nerve (L2-L4) on the affected side. The range of sensory reduction / loss is recorded by comparing with the healthy side. The module has a built-in algorithm for judging the success of the blockade. The blockade is considered successful only when sensory reduction / loss occurs in the innervation areas of both the femoral nerve and the lateral femoral cutaneous nerve.

[0028] The efficacy evaluation module also integrates extended functions such as motor blockade monitoring, anesthetic drug dosage statistics, postoperative analgesia effect tracking, and complication early warning; motor blockade monitoring records quadriceps muscle strength grading (0-5 grade), anesthetic drug dosage statistics accuracy is 0.1mL, and analgesia VAS score (0-10 points) is tracked 72 hours postoperatively, and complications such as vascular injury, nerve injury, and local anesthetic poisoning are graded into I-III levels for early warning.

[0029] The patient preparation and positioning module includes four sub-functions: preoperative visit, vital sign monitoring, positioning, and aseptic operation. The positioning is a lateral decubitus position with the affected side facing up, hip and knee flexed at 90°, and the spine maintaining its natural physiological curvature. Aseptic operation uses iodine in a spiral disinfection process with a disinfection area diameter ≥15cm, and a sterile drape is used to expose the puncture area.

[0030] The system is operated by physicians with anesthesiology qualifications, in a standard anesthesia operating room in a hospital, with medical-grade sterile instruments and an ultrasound image display resolution ≥1024×768.

[0031] Prerequisites for operation in this embodiment: The person performing the procedure: an attending physician / resident physician with anesthesiology practice qualifications; Operating environment: Standard anesthesia operating room in the hospital, ambient temperature 22-26℃, sterility level 100; Supporting equipment: 2-5MHz convex array ultrasound probe, medical sterile ultrasound coupling agent, sterile probe protective cover, 22G×80mm blocking needle, 1% lidocaine (local infiltration anesthesia), 0.3% ropivacaine (blocking medication), 10mL / 20mL sterile syringe, medical iodine tincture, sterile drape, vital signs monitor, sterile injection needle for nerve sensation assessment, medical sterile dressing; Patient requirements: Adult patient, ASA grade I-II, no lumbar anatomical deformity, no allergy to local anesthetics, and no coagulation dysfunction.

[0032] Example 1: Patient preparation and positioning module ( Figure 1 This module is the basic operation module, which includes four sub-functions: preoperative visit, vital sign monitoring, patient positioning, and aseptic operation. The operation steps are as follows: Preoperative visit: Visit the patient one day before the operation, inform the patient of the purpose, procedure, potential risks and expected analgesic effect of psoas muscle block, answer the patient's questions, and sign a written informed consent form; Vital signs monitoring: After the patient enters the room, a multi-parameter vital signs monitor is connected to routinely monitor heart rate (HR), blood pressure (BP), blood oxygen saturation (SpO2), and electrocardiogram (ECG) at a frequency of 1 time / minute; establish a peripheral intravenous access and infuse compound sodium chloride injection at an infusion rate of 3 mL / (kg·h) to maintain the patient's circulatory stability. Standardized positioning: Assist the patient to assume a lateral decubitus position with the affected side facing up, and flex the hip and knee at 90° to fully relax the patient's lower back and expose the operating area; adjust the height and angle of the operating table to maintain the natural physiological curvature of the patient's spine and avoid scoliosis or excessive flexion. Aseptic procedure: Using medical iodine solution as the center, perform spiral skin disinfection from the inside out, with a disinfection area diameter ≥15cm and 3 times. After each disinfection, allow the iodine solution to dry naturally. After drying, drape a sterile drape, exposing only the puncture operation area to ensure the sterility of the operation area.

[0033] Example 2: Ultrasound scanning and trident sign localization module ( Figure 1 Refined operation This module is the core localization module, its core function being the identification of the "trident sign" and the calibration of the intertransverse ligament, combined with... Figure 2 and Figure 3 The operation steps and positioning algorithm are as follows: Ultrasonic probe preparation: Apply sufficient amount of sterile ultrasound coupling agent to the ultrasonic probe and remove air bubbles from the coupling agent; put the probe into a sterile protective sleeve and remove air bubbles between the protective sleeve and the probe again to ensure the clarity of the ultrasound image; Probe placement and section adjustment: The operator stands on the back of the patient and places the probe 3-4 cm away from the spinous process of the patient. The probe is adjusted to a para-sagittal oblique section. The probe is kept perpendicular to the skin to avoid excessive pressure that may cause tissue deformation. Trident sign identification: Slowly slide the probe along the head-to-tail direction at a speed of 0.5 cm / s, and identify the tips of the transverse processes of the L1, L2, and L3 lumbar vertebrae in sequence under ultrasound imaging. The tips of the transverse processes appear as continuously arranged arc-shaped hyperechoic shadows. Figure 2 ), accompanied by clear finger-shaped sound shadows in the background ( Figure 2 The three elements form a typical "trident" pattern. Figure 2 The module confirms that the depth of the transverse process is 2.5-4.0cm (slightly different due to patient body size), and records the anatomical parameters of the transverse process in real time. If the trident sign is not detected, the module will trigger a prompt to adjust the scanning parameters. Correction steps: fine-tune the probe section angle by ±5° and adjust the distance between the spinous processes by 0.5cm increments. Rescan until a clear trident sign is detected. Intertransverse ligament identification and target gap calibration: Fix the probe at the L1-L2 and L2-L3 transverse process segments, slightly adjust the probe angle (±5°) and probe pressure, and identify the thin linear hyperechoic structure between the tips of two adjacent transverse processes under ultrasound imaging. Figure 3 The middle part refers to the intertransverse ligament; deep to this ligament (ventral side) is the hypoechoic, striped psoas major muscle. Figure 3 The tissue, superficially (dorsal), consists of hyperechoic erector spinae muscles. Figure 3 ); Target gap parameter monitoring: The module calibrates the potential gaps deep to the intertransverse ligaments and on the posterior border fascia of the psoas major muscle as the puncture target. Figure 3 It displays the target depth (3.0-3.5cm) and the anatomical distance to surrounding blood vessels / nerves in real time, with a monitoring accuracy of 0.1cm, providing precise anatomical parameters for subsequent punctures.

[0034] Positioning algorithm formula: Precise positioning = Trident sign recognition (transverse process segment positioning) + intertransverse ligament recognition (target space calibration) + real-time monitoring of target space anatomical parameters; Trident sign recognition success rate = 1 - (number of unrecognized attempts / total number of scans) × 100, requiring a success rate ≥ 99%. Example 3: Puncture and Block Implementation Module ( Figure 1 This module is the core operation module, focusing on achieving precise needle tip positioning and standardized drug injection, combined with... Figure 4, Figure 5 The operation steps, puncture algorithm, and drug diffusion algorithm are as follows: Local infiltration anesthesia: Under real-time ultrasound monitoring, 1% lidocaine is used for intradermal and subcutaneous local infiltration anesthesia at a distance of 1.5cm from the probe tail to form a wheal with a diameter of about 1cm, thereby reducing puncture pain; Preparation of the 22G×80mm occlusion needle: Figure 4 Connect a 20mL sterile syringe and purge any air bubbles from the syringe and needle to prevent air embolism. Standardized in-plane puncture: Using in-plane puncture technique, the needle is inserted from the posterolateral to the anteromedial direction along the long axis of the probe, ensuring that the needle path is aligned with the plane of the ultrasound beam. Figure 4 To maintain coplanarity, the needle insertion speed is controlled at 0.5 cm / s. The module monitors the needle insertion speed in real time and triggers a deceleration prompt when the speed exceeds the threshold. If the needle path deviates from the ultrasonic beam plane, the module will trigger a needle path deviation audio-visual prompt. Correction operation: Adjust the needle insertion angle ±3° until the needle tip returns to the ultrasonic beam plane to ensure that the needle tip is clearly displayed in the ultrasound image throughout the process. Dual verification of ligament breakthrough: a pinpoint hyperechoic spot is visible on ultrasound imaging ( Figure 4 As the needle tip gradually approaches the intertransverse ligament, when it contacts the hyperechoic line of the ligament, the operator can feel slight resistance, and the module triggers a resistance sensing prompt. Continue to advance the needle tip smoothly, and when a feeling of emptiness (tactile feedback) occurs where the resistance suddenly disappears, the ultrasound image simultaneously confirms that the strong echo point of the needle tip is located in the potential gap on the surface of the deep ligament and the posterior border fascia of the psoas major muscle (image feedback). When both signals are met, the puncture target is determined to be met, and needle insertion is stopped; when only one signal is met, a needle tip position correction prompt is triggered, and the needle tip position is finely adjusted until both signals are met. Standardized pre-injection procedure: After stopping the needle insertion, aspirate the syringe needle core for ≥5 seconds to confirm that there is no blood, cerebrospinal fluid, or other fluid before proceeding with the injection. If blood / cerebrospinal fluid is aspirated, immediately withdraw the needle 0.5cm and aspirate again. If the aspiration is still abnormal, terminate the procedure. Standardized injection: Slowly inject 22 mL of 0.3% ropivacaine at a rate of 1 mL / s. Continuously monitor the patient's vital signs during the injection. If abnormalities such as increased heart rate or decreased blood pressure occur, stop the injection immediately and take symptomatic treatment. Verification of characteristic drug diffusion: During the injection process, the diffusion pattern of the drug solution was monitored in real time by ultrasound. The drug solution appeared as an anechoic area ( Figure 5 This pushes the intertransverse ligament forward, forming a typical crescent-shaped diffuse shadow between the ligament and the posterior surface of the psoas major muscle. Figure 5Simultaneously, the drug solution slowly diffuses along the surface of the psoas major muscle towards the head and tail of the L1 and L3 segments, without any diffusion of the drug solution into blood vessels, nerve sheaths, or the abdominal cavity, indicating that the drug solution diffusion has met the standard; ○ If the drug solution diffuses diffusely and irregularly without ligament pushing characteristics, it is determined that the drug solution diffusion has not met the standard, and the injection should be stopped immediately. After withdrawing the needle 0.3cm, the target position should be re-verified, and the injection should be resumed only after the standard is met. Postoperative treatment of the puncture site: After the injection is completed, slowly withdraw the needle, press the puncture site with a sterile cotton ball for 3 minutes to stop the bleeding, and apply a sterile medical dressing after there is no bleeding.

[0035] Puncture algorithm formula: Precise needle tip positioning = coplanar needle path in the plane (full needle tip visibility) + ligament breakthrough dual signal verification (image + touch) + real-time monitoring of needle insertion parameters. Ligament breakthrough compliance rate = (number of times dual signals are met / total number of punctures) × 100, with a compliance rate required to be ≥ 98%.

[0036] Drug diffusion algorithm formula: Accurate drug diffusion = target gap sealing (fascial gap) + local anesthetic fluid pressure (injection rate of 1mL / s) + characteristic crescent / fusiform diffusion shadow Drug diffusion compliance rate = (number of characteristic diffusions / total number of injections) × 100, with a compliance rate of ≥97%.

[0037] Example 4: Effect Evaluation Module ( Figure 1 This module is for effect verification, and its core is to achieve an objective evaluation of the blocking effect. The operation steps and effect evaluation algorithm are as follows: Initiation of blockade effect assessment: After the injection is completed, wait 12 minutes (to ensure that the local anesthetic has fully diffused to the lumbar plexus branches), then initiate the effect assessment module. Monitor the patient's vital signs again before the assessment. Standardized acupuncture sensory blockade test (efficacy evaluation algorithm step 1): Using a sterile injection needle, at a fixed frequency of 1 time / second, needle the skin innervation area of ​​the nerve below the affected side sequentially, while simultaneously needle the corresponding area on the healthy side as a control. Ask the patient about their pain sensation and record the range of sensory reduction / absence: Iliohypogastric nerve (T12-L1): 2cm below the umbilicus; Ilioinguinal nerve (L1): Midpoint of the groin area; Lateral femoral cutaneous nerve (L2-L3): Upper 1 / 3 of the lateral thigh; Femoral nerve (L2-L4): Upper 1 / 3 of the anterior thigh; Obturator nerve (L2-L4): Middle 1 / 2 of the medial thigh; Determination of successful blockade (Step 2 of the effect evaluation algorithm): The module has a built-in algorithm for determining the standard of successful blockade. The blockade is considered successful only when there is a decrease / absence of sensation in the innervation areas of both the femoral nerve and the lateral femoral cutaneous nerve. If there is no loss of pain in the innervation area of ​​the core nerve, the blockade is considered to have failed. Depending on the patient's condition, 5-8 mL of 0.3% ropivacaine can be injected, or the puncture operation can be repeated. Extended Functional Monitoring (Effect Evaluation Algorithm Step 3): ○ Motor Blockade Monitoring: Using a 0-5 grade muscle strength grading method, the muscle strength grade of the affected quadriceps femoris is recorded. In this example, the patient's quadriceps femoris muscle strength is grade 3 (mild motor blockade), which meets clinical requirements; ○ Drug Dosage Statistics: The module calculates the total amount of local anesthetic used during surgery in real time. In this embodiment, the total dosage of 0.3% ropivacaine was 22 mL, which did not exceed the clinically safe dose. ○ Complication warning: Continuous monitoring was conducted within 30 minutes after injection. If no immediate complications such as local anesthetic poisoning, vascular injury, or nerve injury occurred, the module was marked as Level I warning (low risk). ○ Postoperative analgesia follow-up: Patients were monitored for analgesia using the VAS score ≤ 3 points 72 hours post-surgery, indicating a good clinical analgesic effect. The efficacy evaluation algorithm formula is: Objective verification of blockade effect = local anesthetic target gap diffusion (nerve conduction blockade) + standardized acupuncture method (pain test, 1 time / second) + core nerve innervation area sensory assessment. Blockade success rate = (number of times sensory loss in the core nerve innervation area / total number of assessments) × 100, requiring a success rate ≥ 95%.

[0038] Example 5: Execution of the Five-Node Judgment-Feedback-Correction Closed-Loop Working Logic One of the core innovations of this invention is the construction of a five-node judgment-feedback-correction closed-loop working logic. The five core judgment nodes are, in order: trident sign recognition node, intertransverse ligament recognition node, ligament breakthrough double verification node, drug diffusion characteristic node, and successful blockage effect judgment node. Each node has a clear judgment standard. The feedback logic is executed by the feedback prompt module, the correction operation module, and the anomaly analysis report generation module. The specific logic is as follows: Once any node meets the judgment criteria, the system automatically records the node data and proceeds to the next node's operation process. If any node fails to meet the judgment criteria, the feedback prompt module will immediately trigger a targeted audio-visual prompt, the correction operation module will push the corresponding correction operation plan, and the physician will re-examine the node after performing the correction operation. If the judgment criteria are still not met after the correction operation, the system will immediately terminate the operation. The abnormal analysis report generation module will automatically generate an abnormal cause analysis report, which includes abnormal nodes, reasons for failure to meet the criteria, deviation of operation parameters, correction operation records, etc., to provide reference for physicians' subsequent operations.

[0039] This closed-loop logic enables full monitoring and real-time correction of the operation process, avoiding invalid operations and complications, and greatly improving the standardization and repeatability of the operation.

[0040] Working principle: The core working principle of the trident sign-based intertransverse ligament psoas major muscle block procedure system of this invention is based on the constant acoustic anatomical landmarks of the lumbar spine. It combines in-plane puncture spatial positioning technology, tactile-imaging dual-signal verification technology, characteristic imaging judgment technology for drug diffusion, and standardized physiological assessment technology for nerve sensation to construct a standardized, closed-loop psoas major muscle block procedure system. Its refined working principle is divided into four core parts: positioning principle, puncture principle, drug diffusion principle, and effect evaluation principle. These principles work collaboratively through a five-node judgment-feedback-correction closed-loop logic, as detailed below: (I) Localization Principle: Under the parasagittal oblique section of ultrasound, the transverse processes of the lumbar vertebrae appear as arc-shaped hyperechoic shadows due to the high reflectivity of bone tissue. Posteriorly, due to sound energy attenuation, finger-like acoustic shadows are formed. The characteristic image arrangement of the L1-L3 transverse processes forms the "trident sign." This landmark is a constant acoustic feature of the lumbar vertebral segments and is not affected by patient body type, anatomical variations, or fat thickness, enabling precise localization of the lumbar transverse process segments. The intertransverse ligament is a dense connective tissue connecting the upper and lower edges of the tips of adjacent lumbar transverse processes. Under ultrasound, it appears as a thin, linear hyperechoic structure. Its deep surface is a potential gap on the posterior border fascia of the psoas major muscle. This gap is a key area for the course of the lumbar plexus and also the target gap for psoas major muscle block. Using the intertransverse ligament as a key landmark for puncture, the target gap can be accurately marked. During the localization process, if the trident sign is not identified, the system triggers a prompt to adjust the scanning parameters. Correction is achieved by fine-tuning the probe section and lateral distance, realizing feedback-correction of localization.

[0041] The puncture principle employs in-plane puncture technology, ensuring that the blocking needle path and the ultrasound beam remain coplanar. This guarantees clear visualization of the needle tip position throughout the entire procedure under ultrasound imaging, preventing blind puncture and achieving full visibility of the needle tip. The puncture path is planned as follows: the needle is inserted 1-2 cm from the probe tail, then from the posterolateral to the anteromedial aspect along the probe's long axis. This path minimizes the needle insertion distance, reducing damage to surrounding tissues and standardizing the puncture path. Ligament breakthrough utilizes a dual verification mechanism of ultrasound imaging and tactile feedback. Utilizing the density of the intertransverse ligament, slight resistance is generated upon needle tip contact, which suddenly disappears upon penetration, creating a feeling of emptiness. Simultaneously, the ultrasound image confirms the needle tip position. This dual-signal verification avoids misjudgment of the needle tip position, ensuring precise entry of the needle tip into the target space. During the puncture process, if the needle path deviates from the ultrasound beam, the system triggers a needle path deviation warning, which is corrected by fine-tuning the insertion angle, achieving feedback-correction during puncture.

[0042] The principle of drug diffusion is as follows: There is a potential loose connective tissue gap between the intertransverse ligament and the fascia at the posterior border of the psoas major muscle. This gap is a closed fascial space. When local anesthetic is injected at a rate of 1 mL / s, the pressure of the liquid will push the intertransverse ligament forward and diffuse it head-to-tail along the fascial space, forming a characteristic crescent-shaped / fusiform anechoic area. This diffusion pattern is an immediate and objective indicator of whether the local anesthetic has been injected into the target space. If the needle tip accidentally enters a non-target space, the drug will diffuse in a diffuse and irregular manner, without the characteristic of being pushed up by the ligament. The system can immediately determine that the drug diffusion is not up to standard, stop the injection, and correct the needle tip position, thus realizing feedback-correction of drug diffusion. The aspiration operation before injection can avoid the needle tip accidentally entering the blood vessel / cerebrospinal fluid, thus preventing complications such as local anesthetic poisoning and nerve damage from the source. (IV) Principle of effect evaluation The lumbar plexus is composed of the anterior branches of the L1-L4 spinal nerves. Its branches, the femoral nerve and the lateral femoral cutaneous nerve, are the core nerves for analgesia in the surgical area related to the lumbar spine. After the local anesthetic diffuses in the target interspace, it will block the conduction of the branches of the lumbar plexus in turn, which is manifested as a decrease / absence of pain in the corresponding skin innervation area. The standardized acupuncture method is used to test the nerve innervation area at a fixed frequency of 1 time / second. The comparison with the healthy side can objectively reflect the range of nerve block. Only when the pain in the innervation area of ​​the femoral nerve + lateral femoral cutaneous nerve disappears is it judged as a successful block, realizing the objective verification of the block effect. During the evaluation process, if the core nerve innervation area does not show a loss of pain, the system judges the block as a failure. It can be corrected by supplementing the injection or re-puncturing, realizing the feedback-correction of the effect evaluation.

[0043] Although embodiments of the invention have been shown and described, it will be understood by those skilled in the art that various changes, modifications, substitutions, and variations can be made to these embodiments, or they can be used directly or indirectly, without departing from the principles and spirit of the invention. In other related technical fields, the scope of the invention is defined by the appended claims and their equivalents, and they are similarly included within the scope of patent protection of the invention.

Claims

1. A system for locating and blocking the psoas major muscle of the intertransverse ligament using the trident sign, characterized in that... The module includes a patient preparation and positioning module, an ultrasound scanning and trident sign localization module, a puncture and blockade implementation module, and an effect evaluation module that work in sequence. Using the "trident sign" under ultrasound imaging of the transverse process of the lumbar vertebra as the basic positioning landmark, and the intertransverse ligament as the key acoustic anatomical landmark for puncture, the in-plane puncture technique combined with tactile loss of feeling and real-time ultrasound imaging is used to achieve precise needle tip positioning. The immediate effect of the block is determined by the characteristic diffusion image of the drug solution, and the physiological effect of the block is verified by the standardized acupuncture method. The system constructs a closed-loop working logic of five nodes: judgment, feedback, and correction. The five core judgment nodes are the trident sign recognition node, the intertransverse ligament recognition node, the ligament breakthrough double verification node, the drug diffusion characteristic node, and the blockage effect success judgment node. If any node fails to meet the standard, the corresponding correction operation is triggered. If the standard is still not met after correction, the operation is terminated and an abnormal cause analysis report is generated.

2. The system for locating the intertransverse ligament and psoas major muscle block of the trident sign according to claim 1, characterized in that: The ultrasound scanning and trident sign localization module uses a 2-5MHz convex array ultrasound probe. It scans a parasagittal oblique section 3-4cm lateral to the spinous process and slides the probe along the head-to-tail direction to identify the tips of the L1-L3 transverse processes. The "trident sign" is accurately identified by the imaging features of the arc-shaped hyperechoic shadow and the posterior finger-like acoustic shadow. The module has a built-in anatomical structure recognition feedback mechanism. If the trident sign is not identified, it triggers a prompt to adjust the scanning parameters. The scanning parameter adjustment includes a ±5° fine adjustment of the probe section angle and an incremental adjustment of the distance lateral to the spinous process in 0.5cm increments.

3. The system for locating the intertransverse ligament and psoas major muscle block of the trident sign according to claim 1, characterized in that: Based on the trident sign recognition, the ultrasound scanning and trident sign localization module identifies the intertransverse ligament by adjusting the probe angle ±5° and the probe pressure. The intertransverse ligament is a thin, linear, hyperechoic structure between the tips of adjacent transverse processes. The module also marks the potential gap on the surface of the fascia at the posterior border of the psoas major muscle deep to the ligament as the puncture target and displays the depth of the target and the anatomical distance from the surrounding tissues in real time. The target depth monitoring accuracy is 0.1 cm.

4. The trident sign localization and intertransverse ligament psoas major muscle block operation system according to claim 1, characterized in that: The puncture and blockade implementation module uses a 22G blockade needle with a length of 80-100mm. It plans an in-plane puncture path with the needle inserted 1-2cm from the tail side of the probe and from the outer side to the inner side along the long axis of the probe. The needle path and the ultrasonic beam are kept coplanar. The module has a built-in needle insertion speed monitoring and needle path deviation warning mechanism. The needle insertion speed control threshold is 0.5cm / s. When the needle path deviates from the ultrasonic beam, an immediate audio-visual prompt is triggered.

5. The trident sign localization and intertransverse ligament psoas major muscle block operation system according to claim 1, characterized in that: The puncture and blockade implementation module constructs a dual-verification ligament breakthrough determination mechanism of ultrasound imaging + tactile feedback: when the strong echo point of the needle tip comes into contact with the high echo line of the ligament under ultrasound, a resistance sensing prompt is triggered. When the needle tip penetrates the ligament and a feeling of sudden loss of resistance occurs, ultrasound simultaneously confirms that the strong echo point of the needle tip is located in the potential gap on the surface of the fascia at the deep surface of the ligament and the posterior edge of the psoas major muscle. When both signals are satisfied, it is determined that the puncture target has been met. When a single signal is satisfied, a needle tip position correction prompt is triggered.

6. The trident sign localization and intertransverse ligament psoas muscle block operation system according to claim 1, characterized in that: After the target site is reached, the puncture and blockade implementation module executes the operation logic of aspirating without blood or fluid → slowly injecting the drug. The aspiration time is ≥5 seconds, the injection rate is 1mL / s, and 20-25mL of 0.3% ropivacaine is injected. The module monitors the drug diffusion pattern in real time with ultrasound. The drug diffusion is considered to be up to standard only when the drug shows crescent-shaped / fusiform diffusion, pushes the intertransverse ligament forward, and diffuses along the head-to-tail direction on the surface of the psoas major muscle.

7. The system for locating the intertransverse ligament and psoas major muscle block of the trident sign according to claim 1, characterized in that: The efficacy evaluation module is activated 10-15 minutes after the injection is completed. Using a sterile injection needle, acupuncture is performed at a frequency of 1 time / second to sequentially test the skin innervation areas of the iliohypogastric nerve (T12-L1), ilioinguinal nerve (L1), lateral femoral cutaneous nerve (L2-L3), femoral nerve (L2-L4), and obturator nerve (L2-L4) on the affected side. The range of sensory reduction / loss is recorded by comparing with the healthy side. The module has a built-in algorithm for judging the success of the blockade. The blockade is considered successful only when sensory reduction / loss occurs in the innervation areas of both the femoral nerve and the lateral femoral cutaneous nerve.

8. The system for locating the intertransverse ligament and psoas major muscle block of the trident sign according to claim 1, characterized in that: The efficacy evaluation module also integrates extended functions such as motor blockade monitoring, anesthetic drug dosage statistics, postoperative analgesia effect tracking, and complication early warning; motor blockade monitoring records quadriceps muscle strength grading (0-5 grade), anesthetic drug dosage statistics accuracy is 0.1mL, and analgesia VAS score (0-10 points) is tracked 72 hours postoperatively, and complications such as vascular injury, nerve injury, and local anesthetic poisoning are graded into I-III levels for early warning.

9. The system for locating the intertransverse ligament and psoas major muscle block of the trident sign according to claim 1, characterized in that: The patient preparation and positioning module includes four sub-functions: preoperative visit, vital sign monitoring, positioning, and aseptic operation. The positioning is a lateral decubitus position with the affected side facing up, hip and knee flexed at 90°, and the spine maintaining its natural physiological curvature. Aseptic operation uses iodine in a spiral disinfection process with a disinfection area diameter ≥15cm, and a sterile drape is used to expose the puncture area.

10. The trident sign localization and intertransverse ligament psoas major muscle block operation system according to claim 1, characterized in that: The system is operated by physicians with anesthesiology qualifications, in a standard anesthesia operating room in a hospital, with medical-grade sterile instruments and an ultrasound image display resolution ≥1024×768.

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