劈胸骨柄同时锁骨离断T2、T3前入路应用解剖学研究
Applied anatomy of the anterior approach to 2nd and 3rd thoracic vertebral bodies with osteotomy of the clavicle and partial median sternotomy
目的 探索安全显露和处理T2、T3椎体的理想前入路方式。 方法 对30例（60侧）经福尔马林固定、红色乳胶灌注的成人尸体标本采用劈胸骨柄同时锁骨部分切断术模拟脊柱T2、T3椎体前入路手术。在该入路中，寻找不同的间隙，暴露可能的椎体节段。 结果 将左颈动脉鞘（左颈总动脉、左颈内静脉、左迷走神经及其颈心支）、左锁骨下动脉、胸导管、颈交感干及左纵隔胸膜一起向外侧牵拉，向内侧牵拉气管、食管、左喉返神经及其分支，向下牵拉左头臂静脉的方式，30例标本均能清楚的显露T1上缘至T3下缘，部分（6例）可达T4中部。 结论 劈胸骨柄和锁骨部分切断入路中，可找到一种显露和处理 T2、T3椎体的安全间隙方法。
Objective To explore an ideal method of exposing and treating 2nd and 3rd thoracic vertebral bodies. Methods 30 adult embalmed cadavers (50 sides) were selected and observed. By modeling the anterior approach, the 2nd and 3rd thoracic vertebral bodies were exposed and treated through dissecting a safe space among superior edge of the aortic arch, left subclavian artery, left common carotid, brachiocephalic trunk and brachiocephalic veins. Results Under the standard left anterior approach combined with osteotomy of the clavicle and partial median sternotomy, through the synostosis between the manubrium and body of the sternum, a safe space can be acquired: left carotid sheath (common carotid, internal jugular vein, vagus nerve and its branches), thoracic duct, truncus sympathicus cervicalis, and left pleura mediastinalis were pulled towards lateral; trachea, esophagus, and left recurrent laryngeal nerve were pulled towards internal; left brachiocephalic vein was pulled towards inferior. T1-T3 can be easily exposed on the total 30 adult human cadavers and T4 also can be observed on partial cases. Conclusions Adequate exposure of 2nd and 3rd thoracic vertibral bodies can be obtained by the above approach. It provides adequate work room for treating them.
[1] 肖建如, 李文平, 邵擎东, 等. 颈胸段脊柱损伤前路减压和内固定术的作用评价
[J]. 第二军医大学学报, 2000, 21 (7): 654-656.
[2] 肖建如, 李文平, 魏海峰. 颈胸段脊柱损伤的临床特点及其前路手术疗效探讨
[J]. 中华创伤杂志, 2001,17 (11): 662-665.
[3] Laidlaw JD. Iso-intense neuroenteric cyst in the lower cervical spine treated with ventral resection and anterior fusion utilising sternal notch exposure: case report, technical note and literature review
[J]. Clin Neurosci, 2003, 10 (5): 606-612.
[4] Toh E, Nomura T, Watanabe M. Surgical treatment for injuries of the middle and lower cervical spine
[J]. Int Orthop, 2006, 30 (1): 54-58.
[5] 肖建如, 贾连顺, 袁文, 等. 上胸椎肿瘤的手术途径及术式探讨
[J]. 中华外科杂志, 2001, 39 (5): 352-355.
[6] Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy: a radiographic analysis with clinical application
[J]. Spine, 2000, 25(8): 910-916.
[7] 滕红林, 王美豪, 贾连顺, 等. 脊柱颈胸交界段的MRI测量及其临床意义
[J]. 中国脊柱脊髓杂志, 2003,11 (4): 216-219.
[8] 滕红林, 贾连顺, 肖建如, 等. MRI测量颈胸角在选择颈胸段脊柱手术入路中的临床应用
[J]. 中国骨伤, 2004, 17 (6):325-328.
[9] Hodgson A, Stock F, Fang H, et al. Anterior spinal fusion: the operative approach and pathological finding sin 412 patients with Pott’s disease of the spine
[J]. Br J Surg,1960, 48:172-178.
[10]Kirkaldy-willis WH, Allen PB, Rostrup O, et al. Surgical approaches to the anterior elements of the spine: indications and techniques
[J]. Can J Surg, 1966, 9(3): 294-308.
[11]Riseborough EJ. The anterior approach to the spine for the correction of deformities of teaxial skeleton
[J]. Clin Orthop Relat Res, 1973, (93):207-214.
[12]Lambiris E, Zouboulis P, Tyllianakis M. Anterior surgery for unstable lower cervical spine injuries
[J]. Clin Orthop Relat Res, 2003, (411): 61-69.
[13]Standefer M, Hardy RW, Marks K, et al.Chondromyxoid fibro.ma of the cervical spine:a case report with a review of literature and description of an operativeapproach to the lower cervical spine
[J].Neurosurgery,1982,11(2):288-292.
[14]Kurz LT, Pursel SE, Herkowitz HN. Modified anterior approach to the cervieothomcic junction
[J]. Spine, 1991,16(Suppl10):542-547.
[15]叶晓健, 贾连顺, 袁文．改Sundaresan法治疗上胸椎肿瘤
[J]. 中华骨科杂志, 2004, 24(8):488-490.
京ICP备08002354号-3/
| 〈 |
|
〉 |
