经腋中线胸腔入路显露T2~5椎体的解剖学观测及其临床意义

doi:10.13418/j.issn.1001-165x.2021.04.003

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中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (4) : 384-388. DOI: 10.13418/j.issn.1001-165x.2021.04.003

应用解剖

经腋中线胸腔入路显露T_2~5椎体的解剖学观测及其临床意义

侯俊¹，　施冬冬²，　潘青²，　陈昌成²，　陈前芬²

作者信息 +

Anatomical study and clinical significance of the middle axillary approach in the treatment of T₂~T₅ vertebral lesions

Hou Jun¹, Shi Dongdong², Pan Qing²，Chen Changcheng², Chen Qianfen²

Author information +

文章历史 +

摘要

目的　观察胸椎体T2~5与毗邻组织结构的解剖关系，探讨经腋中线胸腔入路显露T2~5椎体的可行性。方法　选取10具（20侧）胸廓及上肢完整的福尔马林处理的尸体标本，分别从左侧、右侧经腋中线胸腔入路模拟T2~5椎体手术，逐层解剖至胸椎侧前方，观测该入路皮肤切口长度、肋骨离断处纵向撑开宽度，撑开口上下两端、主动脉弓上缘、奇静脉弓最高点及胸导管平椎体位置，胸交感干至肋头关节前缘的距离，模拟T3椎体切除+肋骨植骨+钢板螺丝钉内固定手术。结果　腋中线皮肤切口的长度为（11.63±0.50）cm，第3肋处撑开宽度为（7.04±0.47）cm；撑开口上下缘分别平T2、T5，主动脉弓上缘平T3者占70%，奇静脉弓最高点平T4者占60%，胸导管从前方跨过T5者占70%；胸交感干至第1 ~ 4肋头关节前缘距离分别为（6.84±0.55）mm、（6.99±0.51）mm、（6.98±0.56）mm、（7.07±0.47）mm；模拟手术野可显露T2~5椎体，各毗邻结构位置相对固定，可安全完成椎体切除+植骨+内固定重建胸椎稳定的手术操作。结论　经腋中线胸腔入路可显露T2~5椎体。

Abstract

Objective　To study the anatomical relationship between thoracic vertebral body (T2~T5) and adjacent tissue structure, and to explore the feasibility of treating the T2~T5 vertebral body lesion through the middle axillary approach.　Methods　Ten (20 sides) formalin-treated cadaveric specimens with intact thoracic and upper limbs were selected to simulate T2~T5 vertebral surgery through the left and right mid-axillary thoracic approaches, respectively, and then dissected layer by layer to the lateral front of the thoracic spine. The length of the skin incision, the longitudinal width of the rib fracture were observed. The upper and lower ends of the opening, the upper edge of the aortic arch, the highest point of the sacral arch, the position of the vertebral body of the thoracic duct, and the distance between the thoracic sympathetic trunk and the anterior edge of the costal joint were extended to simulate the operation of T3 vertebral body resection + rib bone graft + plate screw internal fixation.　Results　The length of the mid-axillary skin incision was (11.63 ±0.50) cm, and the width of the third rib was (7.04±0.47) cm. The upper and lower ends of the brace were flat on the 2nd and 5th thoracic vertebrae. The upper edge of the aortic arch flat T3 was 70%, the highest point of the venous arch flat T4 was 60%, and the thoracic duct crossing T5 from the front was 70%. The distance from the sympathetic trunk to the leading edge of the first rib joint was (6.84±0.55) mm, (6.99±0.51) mm, (6.98±0.56) mm, (7.07±0.47) mm, respectively. The simulated surgical field can exposed the T2~T5 vertebra. The adjacent structures were relatively fixed, which can safely and effectively complete the surgical operation of removing the bone graft and internal fixation and reconstructing the stability of the thoracic spine. Conclusions　The middle axillary approach is a treatment for T2~T5 vertebral lesions, which has the advantages of good visual field, less trauma, and high safety.

导出引用

侯俊, 施冬冬, 潘青, 陈昌成, 陈前芬. 经腋中线胸腔入路显露T_2~5椎体的解剖学观测及其临床意义[J]. 中国临床解剖学杂志. 2021, 39(4): 384-388 https://doi.org/10.13418/j.issn.1001-165x.2021.04.003

Hou Jun, Shi Dongdong, Pan Qing, Chen Changcheng, Chen Qianfen. Anatomical study and clinical significance of the middle axillary approach in the treatment of T₂~T₅ vertebral lesions[J]. Chinese Journal of Clinical Anatomy. 2021, 39(4): 384-388 https://doi.org/10.13418/j.issn.1001-165x.2021.04.003

中图分类号： R323

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