颈胸交界处病变的颈前路手术治疗

Anterior cervical approach for cervical-thoracic junctional lesions operations

[目的]探讨颈胸交界处病变的颈前路治疗的手术方式和疗效。[方法]自1997年8月-2008年11月期间22例颈胸交界处病变的患者,采用经颈前路不劈开胸骨的手术路径,暴露病变的颈胸椎交界处（C6-T5）,对病变进行清除、减压、植骨内固定。22例病人,其中椎体结核5例,椎管狭窄8例,椎体发育不良1例,肿瘤5例,创伤3例,年龄在13-74岁,平均32.3岁。术前通过X线和MR I进行评估,所有入选的病例其胸骨切迹水平所对的椎体位于病椎以远。[结果]全部患者安全完成手术,病灶清除和减压彻底,植骨融合或骨水泥填充,钢板内固定。11例多节段病变（大于3个节段）或者有后凸的病人需要行前后路联合的内固定治疗。所有手术顺利完成。术后随访12-74个月,平均28.5个月,除2例肿瘤患者死亡外,其余患者全部获得骨性融合。[结论]颈胸交界处病变,术前进行仔细评估胸骨切迹所对椎体,如果位于病椎以远,采用颈前路延长切口,能够获得良好的显露,能够进行良好的减压和固定。对于多节段的病例或者有后凸的病例行后路的固定稳定脊柱是必要的。

[Objective]To investigate the method of anterior cervical approach for cervical-thoracic junctional lesions operations. [Methods]Twenty-two cases of cervical-thoracic junctional lesions,5 cases with tuberculosis,8 cases with stenosis,5 cases with tumor,1 case with dysplastic and 3 cases with traumatic fracture,were operated via anterior cervical approach without sternotomy during Aug.1997 to Nov.2008.The mean age were 32.3 years（range,13~74）.All cases were estimated before surgery to make sure the sterual manubrium level was lower than the distal vertebra of the disease.[Results]All cases can be exposed clearly by anterior cervical approach with non-sternotomy.All surgeries reeeived decompressions,debridement,reconstruction and bone graft.Eleven cases with multilevel lesions（more than 3 levels） or kyphosis needed anterior combined posterior fixation and fusion.All cases except 2 tumor cases were followed up for 28.5 months（range,12~74 months）.All cases achieved bone fusion at the latest follow-up.[Conclusion]Cervical-thoracic junctional lesion can be operated via anterior cervical approach without sternotomy if the manubrium level is lower than the distal vertebra of the disease.Cases with multilevel lesions or kyphosis need additional posterior fixation and fusion.