上胸椎手术途径探讨(附21例报告)

Study of the operative approach of the upper thoracic vertebrae (report of 21 cases)

[目的]研究胸骨柄切迹与胸椎水平对应关系,并据此作为参考探讨上胸椎的手术途径。[方法]取800例站立位X线胸平片,男女各400例,按20岁以下、20～39岁,40～59岁、59岁以上4个年龄段各100例,观测其胸骨柄切迹与上胸椎水平位置对应关系。据此参考进行上胸椎手术21例,骨折脱位7例,肿瘤9例,结核3例,后纵韧带骨化2例;病变部位T16例,T27例,T32例,T43例,T1、22例,T2、31例;手术途径采取经下颈椎低位前方入路7例,其中T1、21例,T21例,经改良胸骨柄入路9例,其中T31例,经右侧肩胛骨下后外侧胸腔入路5例。[结果]胸骨柄切迹水平对应胸椎人数比例从T1到T3逐步明显增加态势,到T4明显减少。其中胸骨柄切迹平对T1、2占1%,平对T2占5.5%,平对T2、3占15.875%,平对T3占43.5%,平对T3、4占20.75%,平对T4占13.375%,这种分布态势与年龄及性别均无明显相关性。上胸椎手术21例,术中显露满意操作顺利,近期效果满意,1例肿瘤术后9个月死于全身转移,脑脊液漏1例,喉返神经损伤3例。[结论]应根据上胸椎病变的部位选择相应的手术途径,术前观察胸骨柄切迹与胸椎水平对应关系对选择手术入路有临床参考价值。

[ Objective] To investigate the anatomical relation between manubrium sternum incisure （MSI） with the level of upper thoracic vertebrae （UTV） and to find out the basis of operative approach of UTV. [Method] Standing pan chest radiographs of 400 male and 400 female were equally divided into 4 year groups： ≤ 19 years, 20 -39 years, 40 - 59 years and ≥60 years and were used to observe the relationship between MSI with the level of UTV. On the basis of this relationship, a suitable UTV approach was advocated. There were fracture and dislocation of UTV 7 cases, UTV tumor 9 cases, tuberculosis of UTV 3 cases ; OPLL ossification of UTV 2 cases. Diseases located at F1 6 cases, T2 7 cases, T3 2 cases, T4 3 cases, T1,2 2 cases, T2,3 1 case. Lower anterior cervical approach was performed for 7 cases including T1,2 one ease and T2 one case, improved T3 1 case, and right subscapular transthoracic posterolateral approach was used for 5 cases. [ Result ] The number of UTV in relationship with the level of MSI was successively increased from T1 to T3 and was gradually decreased on T4 , i, e, rate of cases of level of MST in relationship with T1 ,2 level was 1% , to T2 level 5, 5% , to T2,3 level 15.87%, to T3 level 43, 5% , to T3,4 level 20, 75% , to T4 13. 375%, No relationship was tound in trend of distribution with the age and gender. The operative approach of UTV according its relationship with MSI was performed with the advantages of satisfactory exposure easily manipulation and satisfactory clinic results in most follow-up cases, One case died of metastasis of tumor in 9 months, 3 cases were complicated with cerebrospinal fluid leakage and 3 cases with injury of recurrent laryngeal nerve. [ Conclusion] Approach to UTV should be selected according to its relationship between MSI and diseased UTV preoperatively. The operative approach of UTV according to its relationship with MST has the advantages of satisfactory exposure, easily manipulation and satisfactory clinic results.