经腋中线胸腔入路显露T_(2~5)椎体的解剖学观测及其临床意义  

Anatomical study and clinical significance of the middle axillary approach in the treatment of T_(2)-T_(5) vertebral lesions

作　　者：侯俊 施冬冬 潘青 陈昌成 陈前芬[2] Hou Jun;Shi Dongdong;Pan Qing;Chen Changcheng;Chen Qianfen(Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine of Yulin City,Yulin 537000,Guangxi Province,China;Department of Orthopedics,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Province,China)

机构地区：[1]玉林市中西医结合骨科医院,广西玉林537000 [2]广西医科大学第二附属医院骨科,广西南宁530007

出　　处：《中国临床解剖学杂志》2021年第4期384-387,共4页Chinese Journal of Clinical Anatomy

基　　金：广西自然科学基金(2017GXNSFAA198300)。

摘　　要：目的观察胸椎体T_(2~5)与毗邻组织结构的解剖关系,探讨经腋中线胸腔入路显露T_(2~5)椎体的可行性。方法选取10具(20侧)胸廓及上肢完整的福尔马林处理的尸体标本,分别从左侧、右侧经腋中线胸腔入路模拟T_(2~5)椎体手术,逐层解剖至胸椎侧前方,观测该入路皮肤切口长度、肋骨离断处纵向撑开宽度,撑开口上下两端、主动脉弓上缘、奇静脉弓最高点及胸导管平椎体位置,胸交感干至肋头关节前缘的距离,模拟T_(3)椎体切除+肋骨植骨+钢板螺丝钉内固定手术。结果腋中线皮肤切口的长度为(11.63±0.50)cm,第3肋处撑开宽度为(7.04±0.47)cm;撑开口上下缘分别平T_(2)、T_(5),主动脉弓上缘平T_(3)者占70%,奇静脉弓最高点平T_(4)者占60%,胸导管从前方跨过T_(5)者占70%;胸交感干至第1~4肋头关节前缘距离分别为(6.84±0.55)mm、(6.99±0.51)mm、(6.98±0.56)mm、(7.07±0.47)mm;模拟手术野可显露T_(2~5)椎体,各毗邻结构位置相对固定,可安全完成椎体切除+植骨+内固定重建胸椎稳定的手术操作。结论经腋中线胸腔入路可显露T_(2~5)椎体。Objective To study the anatomical relationship between thoracic vertebral body(T_(2)-T_(5))and adjacent tissue structure,and to explore the feasibility of treating the T_(2)-T_(5) vertebral body lesion through the middle axillary approach.Methods Ten(20 sides)formalin-treated cadaveric specimens with intact thoracic and upper limbs were selected to simulate T_(2)-T_(5) vertebral surgery through the left and right mid-axillary thoracic approaches,respectively,and then dissected layer by layer to the lateral front of the thoracic spine.The length of the skin incision,the longitudinal width of the rib fracture were observed.The upper and lower ends of the opening,the upper edge of the aortic arch,the highest point of the sacral arch,the position of the vertebral body of the thoracic duct,and the distance between the thoracic sympathetic trunk and the anterior edge of the costal joint were extended to simulate the operation of T_(3) vertebral body resection+rib bone graft+plate screw internal fixation.Results The length of the mid-axillary skin incision was(11.63±0.50)cm,and the width of the third rib was(7.04±0.47)cm.The upper and lower ends of the brace were flat on the 2nd and 5th thoracic vertebrae.The upper edge of the aortic arch flat T_(3) was 70%,the highest point of the venous arch flat T_(4) was 60%,and the thoracic duct crossing T_(5) from the front was 70%.The distance from the sympathetic trunk to the leading edge of the first rib joint was(6.84±0.55)mm,(6.99±0.51)mm,(6.98±0.56)mm,(7.07±0.47)mm,respectively.The simulated surgical field can exposed the T_(2)-T_(5) vertebra.The adjacent structures were relatively fixed,which can safely and effectively complete the surgical operation of removing the bone graft and internal fixation and reconstructing the stability of the thoracic spine.Conclusions The middle axillary approach is a treatment for T_(2)-T_(5) vertebral lesions,which has the advantages of good visual field,less trauma,and high safety.

关 键 词：胸椎 腋中线 手术入路 解剖 内固定 

分 类 号：R323[医药卫生—人体解剖和组织胚胎学]