颈胸段脊柱前方入路手术的应用解剖

Applied anatomy of cervicothoracic spine anterior approach operation

目的探讨颈胸段脊柱前路手术的解剖学依据。方法选取39具尸体，通过模拟胸骨柄和部分锁骨切除的颈胸段脊柱前路术式暴露椎体的步骤，采用连续层次解剖法，由外到内、由浅人深重点观察C5-T3椎体前方在前路途径中必须牵开和需要保护的几个重要结构，并测量相关重要参数。结果左头臂静脉长度为（67．8±11．2）mm，其与头臂干交点距胸骨上切迹的垂直距离为（52．6±21．3）mm，左静脉角与前正中线的水平距离为（43．3±8．8）mm；胸膜顶最高点距锁骨内1／3上缘的垂直距离：左侧（8．1±2．2）mm、右侧（13．1±2．9）mm，左右两侧差异有统计学意义（P〈0．05）；胸导管弓最高点距环状软骨水平的垂直距离和距前正中线的水平距离分别为（19．2±4．3）mm和（34．1＋2．1）mm；右喉返神经穿入脏筋膜位置位于C7-T1椎间水平6例，占15．38％。位于T1椎体上半部水平33例，占84．62％；其与颈总动脉内侧缘交叉点位于T1上半水平9例。位于T1下半水平30例，分别占23．08％和76．92％。结论颈胸段脊柱的前路术式采用经胸骨柄和部分锁骨切除方式可使C5-T3充分暴露，只有熟悉了局部解剖才能佑前路手术得以诈常开展．从而降低疾源件并寿疗管毕率．

Objective To explore the anatomical basis of cervicothoracic spine anterior operation. Methods A total oI 39 bodies were selected. Through simulating the steps of exposure of the vertebral body by sternal and clavicular re- section of cervicothoracic spine anterior surgery, rehional anatomy method was used to observe the C5-T3 vertebral body must be retracted and important structures of several protection in anterior approach from outside to inside, from the shallower to the deeper, then some important parameters were measured. Results The left brachiocephalic vein length was （67.8±11.2） mm, the vertical distance and brachiocephalic trunk node from the suprasternal notch was （52.6±21.3） mm, the horizontal distance of left venous angle and anterior midline was （43.3±8.8） mm. Vertical distance from the peak of pleura to 1/3 superior border of left clavicle was （8.1±2.2） mm, while, （13.1±2.9） mm on the right, the distance between left and right had significant difference （P 〈 0.05）. The vertical distance and the horizontal dis tance from the peak of arch of thoracic duct to cricoid cartilage level and anterior midline were （19.2±4.3） mm and （34.1±2.1） ram. 6 cases of right recurrent laryngeal nerve penetrated the visceral fascia located in C1-T1 intervertebral level, accounting for 15.38%, 33 cases located in the upper T1 vertebral level, accounting for 84.62%. The crossing points of fight recurrent laryngeal nerve and medial border of carotid artery located in T1 upper level were 9 cases, lo- cated in T1 lower level were 30 cases, accounting for 23.08% and 76.92% respectively. Conclusion Application of sternal and clavicular resection in the cervicothoracic spine anterior approach operation can make the C5-T3 fully ex- posed, only familiar with local anatomy can make the anterior operation normally developed, in order to decrease the incidence of iatrogenic comolications.