摘要
[目的]探讨经胸骨上段行颈胸段脊柱前路手术的方法和临床效果。[方法]自1999年8月～2006年2月共治疗11例颈胸段病变患者，男8例，女3例；年龄17～67岁，平均41．5岁。病变类型：创伤、肿瘤和结核各4、6和1例。病变节段：T3、C7～T1和T1.2各1例，C7和C6～T1各2例，4例T1。手术取颈胸部联合切口，劈开胸骨上段，显露颈胸段椎体，切除肿瘤或病变椎体、脊髓减压、重建脊柱的稳定性和内固定。脊髓神经功能按Frankel分级评定。[结果]术后随访10～56个月，平均31个月。1例术后第2d出现乳糜漏约50ml，引流2d后自愈。1例出现暂时性声音嘶哑。术后脊髓功能均有不同程度恢复。无骨不融合及内固定失败，脊柱稳定性好。[结论]经胸骨上段行颈胸段脊柱前路手术显露满意，创伤小，手术操作安全，并发症少，可满足颈胸段椎管前方减压、植骨融合及内固定术。应注意避免喉返神经和胸导管的损伤。
[ Objective] To explore the operative method through the trans-upper-sternal approach in the treatment of the eervieothoraeie spinal lesions and evaluate its clinical effects. [ Method] From August 1999 to February 2006, 11 cervicothoraeie patients, 8 males and 3 females, age ranged from 17 to 77 years with a mean of 41.5 years underwent the trans-uppersternal approach surgical treatment. There were four traumatic lesions, six tumors and one tuberculosis. The lesions were located at T3 , C7 - T1 and T1.2 in 1 ease respectively, C7 and C6 - T1 in 2 eases respectively, T1 in 4 eases. The combined eervieothoraeie incision and upper sternotomy were performed for the exposure of the vertebral bodies, then tumor or vertebral body was reseeted, the spinal cord was decompressed, the spinal column was reconstructed and fixed. Neurologie status was assessed using the Frankel classification. [ Result ] The duration of follow-up ranged from 10 to 56 months with an average of 31 months. One patient developed ehyle leakage of 50 ml one day after surgery and the leakage stopped 2 days after continuous drainage. One patient had transient vocal cord paresis which recovered in 3 months. All patients had their neurological improvement at different level. Nonunion or instrument-related complications were not observed, and the vertebral column had good stability. [ Conclnsion] The trans-upper-sternal approach gives an excellent exposure of the eervieothoraeie junction. It is a technically simple, safe and effective method for anterior decompression, maintenance of anatomic alignment, fusion with bone graft and internal fixation with less complications and trauma. Attention should be paid to avoid injury of the recurrent laryngeal nerve and the thoracic duet.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第9期656-659,共4页
Orthopedic Journal of China
关键词
外科入路
颈胸段
手术治疗
surgical approach
eervieothoraeie junction
operative treatment
