颈胸段脊柱椎体周围重要脉管结构的应用解剖

Applied anatomy of vessels around cervicothoracic spine

目的:为颈胸段脊柱选择合理的前方入路提供解剖学依据。方法:在30具成人尸体上,观察颈胸段脊柱周围重要脉管的解剖分布及毗邻关系。结果:①胸导管在T5水平由椎体右侧越中线向左移行,在T4椎体左前方上行到T2水平,再行向左上方,80%在C7～C7/T1水平呈弓状注入左静脉角或锁骨下静脉内侧段。②70%的主动脉弓顶点对应T3椎体水平。胸主动脉中轴线到椎体前正中线(PVM)距离在T4水平大于在主动脉弓顶点和T5水平。③63%的上腔静脉(SVC)起点对应T3椎体水平。SVC起点到PVM及SVC中轴线分别在T4、T5水平到PVM的距离逐渐增大。左右头臂静脉与PVM的夹角分别为:59.35°±5.40°和33.62°±5.59°。左侧大于右侧(P<0.05)。奇静脉在SVC的注入点87%位于T3/4～T4水平。结论:应根据不同的病变节段选择合理的颈胸段脊柱前方手术入路,上位椎体应选经左侧低位下颈椎前方入路或偏左侧部分劈开胸骨柄入路,下位椎体应选择右侧经胸腔入路或偏右侧劈胸骨入路。

To provide anatomic data for selecting optimal anterior approach to different segments of cervicothoracic spine （CTS）. Methods： Anatomic relationships of important vessels around CTS were observed on 30 adult cadavers. Rcgults： （1） Thoracic duct （TD） passed through prevertebral midline（PVM） from the right to the left side of vertebral body （VB） at the level of T5, and reached the level of T2 VB along the left anterior aspect of T4VB, continued through the left superior aspect of T2 VB, and then 80% thoracic duct arch （TDA） drained into left venous angle or the medial part of subclavian veine at C7-C7/T1 level. （2） For 70% specimens, the peak of aortic arch （AA） was at the level ofT3 VB. The distance between PVM and the midline of the thoracic part of aorta at the level ofT4 VB was more longer than that at the level of the peak ofAA or at T5 VB. （3） For 63% specimens, the origin of superior vena cava （SVC） was at the level of T3 VB, The distance between PVM and the start of SVC or the midline of SVC increased gradually from T4 to T5 VB. Angles between PVM and the midline of left or right brachiocephalic vein （BV） was 59.35°±5.40° and 33.62°±5.59° respectively, and there was difference between the left and right sides （P〈0.05）. For 86% specimens, the draining point of azygos vein （AV） into SVC was at the level of T34 -T4 VB. Conclusions： Reasonable approaches of CTS should be selected according to different segments of pathological VB： anterior approach of the lower cervical vertebrae or transsternal approach from the left side for the upper segments of VB, while transsternal approach along the right side or transthoracic approach for the lower segments of VB.