颈胸段前方手术入路的临床应用及相关解剖学研究

发布时间：2018-07-16 21:34

【摘要】： 脊柱颈胸段疾病在脊柱外科领域占有重要地位,随着外科治疗理论和技术的不断进步,外科手术日益成为脊柱颈胸段疾病的重要手段。对于脊柱疾病,尤其是脊柱颈胸段的手术显露是脊柱外科的难点之一。脊柱颈胸椎段(C7—T3)处于颈椎前凸到胸椎后凸的移行部位,前有胸骨、纵隔阻挡,位置深在,前方重要的神经、血管及淋巴管纵横交错。临床上引起脊髓压迫的绝大部分病变如肿瘤、感染以及退行性病变等疾病都来自脊髓的前方,因此,脊柱手术入路的选择也逐渐从后路减压、后外侧减压转向了前方手术入路直接减压。但是,此处前方结构复杂,由于其解剖结构的特殊性,对累及C7—T3椎体的病变手术时显露困难,容易损伤周围的组织结构,增加了手术难度和风险。因此,有必要对其局部解剖结构进行深入研究。本论文从临床分析和解剖学角度,探讨脊柱颈胸段的术中显露及如何避免并发症,减少手术风险;强调右侧喉返神经在经右侧施行T1,2椎体手术时易受损伤,行左侧入路手术时如熟悉胸导管的走行,可避免损伤,同时术中操作应注意避免颈交感干的损伤。本论文比较经不同的血管、神经间隙进行显露及手术操作时的风险性和优缺点,以减少并发症,提高手术疗效,为手术方案的设计提供参考。
[Abstract]:The disease of cervical and thoracic segment of spine plays an important role in the field of spinal surgery. With the development of surgical treatment theory and technology, surgical surgery has become an important means of cervical and thoracic spinal diseases. The surgical exposure of spinal diseases, especially the cervical and thoracic segments of the spine, is one of the most difficult points in spinal surgery. The cervical thoracic vertebrae (C7-T3) is located in the transitional position from the anterior cervical spine protruding to the thoracic kyphosis, with sternum, mediastinal obstruction, deep position, and crisscross of the important nerves, vessels and lymphatic vessels in the front. Most of the diseases that cause spinal cord compression clinically, such as tumors, infections and degenerative diseases, all come from the anterior side of the spinal cord. Posterolateral decompression shifted to direct decompression via the anterior approach. However, because of the particularity of the anatomical structure, it is difficult to expose the lesions involving C7-T3 vertebrae, and it is easy to damage the surrounding tissue structure, which increases the difficulty and risk of the operation. Therefore, it is necessary to study the local anatomical structure. From the angle of clinical analysis and anatomy, this paper discusses the intraoperative exposure of the cervical and thoracic segments of the spine and how to avoid complications and reduce the risk of surgery, and emphasizes that the right recurrent laryngeal nerve is vulnerable to injury during the operation of the right side of the T _ 1O _ 2 vertebra. If you are familiar with the thoracic catheter, the injury can be avoided during the operation of the left approach, and the injury of the sympathetic trunk of the neck should be avoided during the operation. In this paper, the risks, advantages and disadvantages of exposure and operation of different blood vessels and nerve spaces were compared to reduce complications, improve the curative effect and provide reference for the design of surgical scheme.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R687.3;R322

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