经胸骨上段入路显露颈胸段的解剖学研究和临床应用

发布时间：2018-06-26 04:37

  本文选题：颈胸段 + 脊柱　； 参考：《郑州大学》2005年硕士论文

【摘要】：颈胸段脊柱是指颈椎和胸椎的移行部分,主要是指C_6-T_2四个椎体。对来自颈胸段脊髓前方的压迫,需采用前入路手术直接显露病变部位,以便减压。颈胸段前方解剖结构复杂,显露困难,目前尚无一种成熟理想的手术入路。作者1997年3月-2005年1月采用经胸骨上段入路手术治疗颈胸段脊髓压迫症患者16例,术野显露充分,治疗结果满意。 资料与方法 本组16例,男11例,女5例;年龄33-67岁,病程10天-2年。病变部位:C_(6-7)、C_6-T_1、T_(1-2)、T_2和T_3各1例,C_73例,C_7-T_13例,T_15例。病变类型:骨折4例,骨折合并脱位6例,浆细胞瘤、结核、纤维脂肪血管瘤、肺癌转移、食管癌转移和不明原发病灶均1例。术前脊髓神经功能按Frankel分级:A级2例均为骨折;B级4例:不明原发病灶和浆细胞瘤各1例,骨折2例;C级6例:转移性肺癌、转移性食管癌和结核各1例,骨折脱位3例;D级4例:纤维脂肪血管瘤1例。骨折脱位3例。14例伴括约肌功能障碍。 患者均有不同程度的颈胸背部疼痛,局部有压痛、扣击痛和颈胸段脊柱活动受限。1例左侧肩部、前臂疼痛、麻木,1例双肩痛并向双上肢放射,1例双上肢麻木,1例中、环和小指麻木,4例乳头以下麻木、感觉减退、双下肢肌力减弱(Ⅰ-Ⅳ级)和双膝腱发射亢进,1例乳头以下运动、感觉完全丧失。3例出现心动过缓(心率50-58bpm),1例出现低血压,1例出现右侧Horner征,1例合并应激性胃溃疡、肺部感染和左小腿筋膜室综合症,1例合并食管癌伴肺转移、左侧胸腔积液和肺不张,1例合并胸膜钙化和冠心病(隐匿型),1例合并肺癌并纵隔淋巴结转移。
[Abstract]:The cervical and thoracic spine refers to the transitional part of the cervical and thoracic vertebrae, mainly C6-T _ T _ 4 vertebrae. Anterior approach should be used to expose the lesion directly to decompress the anterior cervical and thoracic spinal cord. The anatomic structure of anterior cervical and thoracic segment is complex and difficult to expose, so there is not a mature and ideal surgical approach. From March 1997 to January 2005, 16 patients with cervical and thoracic spinal cord compression were treated by transsternal approach. The surgical field was fully exposed and the results were satisfactory. Materials and methods 16 cases, male 11, female 5, aged 33-67 years, the course of disease was 10 days-2 years. The lesion site: C _ (6-7) / C _ 6-T _ (1) T _ (1-2) T _ (2) T _ (2) and T _ 3 (n = 1) respectively; There were 4 cases of fracture, 6 cases of fracture with dislocation, 1 case of plasmacytoma, 1 case of tuberculosis, 1 case of fibrous adipose hemangioma, 1 case of metastasis of lung cancer, 1 case of metastasis of esophageal carcinoma and unknown primary lesion. According to Frankel grade, 2 cases of spinal cord nerve function were classified as fracture B grade 4 cases: 1 case with unknown primary lesion and 1 case with plasmacytoma, 6 cases with fracture with grade C, 1 case with metastatic lung cancer, 1 case with metastatic esophageal carcinoma and 1 case with tuberculosis. 3 cases of fracture and dislocation 4 cases of D grade: 1 case of fibrous adipose hemangioma. 3 cases with fracture and dislocation. 14 cases with sphincter dysfunction. All the patients suffered from neck, chest and back pain, local tenderness, clasping pain and limited movement of the cervical and thoracic spine in 1 case, left shoulder pain, forearm pain, numbness in 1 case, double shoulder pain and radiation to both upper limbs in 1 case, in which 1 case had bilateral upper limb numbness, 1 case had pain in the left shoulder, 1 case had numbness in the forearm, and 1 case had bilateral upper limb numbness. Ring and finger numbness were found in 4 cases with subnipple numbness, hypoaesthesia, lower limb muscle strength (grade 鈪，

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