经后外入路上胸椎椎体切除的CT影像测量研究

Evaluation of Minimally Invasive Posterolateral Upper Thoracic Corpectomy Based on CT Measurement

目的研究后外侧微创入路上胸椎（T2-5）单节段椎体切除术中套管位置变化对椎体、椎管减压程度的影响。方法收集60例成人上胸椎（T2-5）CT影像资料,男女各30例。每个节段选择一个层面,用2条平行线代表套管,模拟椎体切除。每个层面选择3个位置：a）套管经一侧肋横突关节外侧缘,并与同侧椎体皮质相切;b）套管外移3 cm;c）套管外移5 cm。比较各节段不同位置间椎体、椎管减压程度的差异。结果同一节段,相同位置,男女椎体、椎管减压率无明显统计学差异,P〉0.05;但位置1与2,1与3,2与3,椎体、椎管减压率均有明显统计学差异,P〈0.01;套管外移5 cm,切除肋骨长度、胸膜挤压距离、操作距离增加,分别为50.42-62.90 mm、1.67-5.53 mm、124.35-140.37mm。结论后外侧微创入路上胸椎（T2-5）单节段椎体切除,套管位置对椎体、椎管减压程度影响明显;术中套管外移3 cm最佳,手术创伤较小,操作方便,胸膜、脊髓损伤概率相对低。

Objective To evaluate the effects of the position of the retractor on the extent of corpectomy and ventral decompression in minimally invasive posterolateral single-level upper thoracic（T25） corpectomy.Methods A total of 60 adult T25 CT images were collected,male 30,female 30.The retractor was Abstracted as two parallel lines and simulated operations were performed on one selected image.There were 3 positions each image：a）The retractor passes through the lateral border of the costotransverse articulation and tangent to ipsilateral vertebral body cortex;b）The retractor shifts 3 cm laterally;c）The retractor shifts 5 cm laterally.Compare the extent of corpectomy and ventral decompression between the groups each level and find the statistic difference.Results No significant statistic difference in extent of corpectomy and ventral decompression was noted between males and females at the same position,P〉0.05;While a significant difference was noted between position 1 and the more lateral positions,P〈0.01;Position 3 required more rib resection（50.4262.90 mm）,longer working distances（124.35140.37 mm） and more severe plural disturbing（1.675.53 mm）.Conclusion The position of the retractor have obvious influence on the extent of corpectomy and ventral decompression in minimally invasive posterolateral single-level upper thoracic（T25） corpectomy.It appears optimal the retractor shifts 3 cm laterally during the operation,which made the operation more convenient with less wound and lower incidence of plural and spinal cord injury.