上胸段病变的经胸骨前入路手术治疗

Operation of upper thoracic spine diseases through anterior transsternal approach

[目的]探讨上胸段病变的经胸骨前入路治疗的手术方式。[方法]介绍5年来对6例颈胸交界椎疾患的患者,采用经胸骨前入路的手术方法,暴露病变的上胸段椎体(T1～4),对病变予以清除、减压、植骨内固定,并对相关文献予以复习。[结果]6例患者分别为C7椎体完全移位1例,T1、2椎体结核1例,颈胸结合部肿瘤2例,T2、3椎间盘突出1例,C7T1骨折1例。年龄11～82岁;平均37.3岁。均采用经胸骨前入路,手术入路显露良好,病灶暴露充分。术后平均随访12.4个月。除1例肿瘤患者术后复发,1例术后呼吸道梗阻死亡外,余4例患者均获得满意疗效。[结论]颈胸交界处椎体疾病的发生率较低,此部位结构复杂,单纯颈部入路不能很好的显露T2、3椎体,经胸侧入路对于上胸椎也难以显露,经胸骨前入路可以很好的暴露下颈椎及T4以上椎体,该入路对颈胸交界处椎体的病变的处理是一种很好的选择。

[ Objective ] To investigate the method of anterior transsternal approach for the patients with upper thoracic spine diseases and the clinic results. [Method] Six cases upper thoracic spinal diseases, 1 case of C7/T1 grade V dislocation, 1 case of T1、2 TB, 2 cases of upper thoracic tumor, 1 case of T2 fracture and 1 case of T2、3 disc prolapse, were treated with the anterior transsternal approach operation since Oct. 2001. The lesions areas were exposed via partial or complete sternotomy. The relative articles were reviewed. [ Result] The average follow-up was 12. 4 months （ range from 6 to 22 months, except the died one）. The case of C7/T1 grade V dislocation died of respiratory tract obstruction and one case of malignant schwannoma recurred 6 months post-operation. Good results were obtained in the other 4 cases. No operative complication happened in all cases. [ Conclusion] While the transthoracic lateral approach cannot expose the upper thoracic spine clearly, the anterior cervical approach cannot expose the T2、3 clearly also. The anterior transstemal approach can provide a safe access to the lesions located on the upper thoracic spine above T4.