胸椎腹侧显露的外科解剖学研究

目的研究胸段椎管骨性结构的形态及相互关系，为胸段椎管腹侧显露的手术入路研究提供解剖学依据。方法在15副成人胸椎椎管及其周围骨性结构的形态及相互关系的观察和测量的基础上，取成人湿性胸段脊柱标本6副，切除部分胸椎侧方结构以观测是否能改善椎管腹侧的暴露范围及视角。采用螺旋CT薄层扫描胸段脊柱，然后应用efilm软件分析相关数据。结果胸椎椎管相对较小，胸椎的上关节突从后上方观察呈-“V”字形，T1的上关节突间距离最宽，向下逐渐减小，至T5、T6节段最小；胸椎的横突向后侧方倾斜，其与正中矢状面所成的角度从第一胸椎至第十胸椎越来越小，这些结构特点构成了后方入路显露胸椎腹侧的障碍。通过对湿性标本模拟手术入路对骨窗咬除后CT扫描观测对椎管腹侧的暴露，侧前方手术人路视角最大，较联合经椎弓根一关节突入路的视角增加约20°角。结论传统的后方入路暴露胸椎椎管的腹侧较为困难；椎弓根、胸椎横突及与之相连的部分肋骨是侧方到达椎管前方的主要骨性障碍，胸椎侧前方人路可以是胸椎腹侧占位的更好的选择。

Anatomic study on exposion of ventral thoracic vertebral canal

Objective To study the morphology, dimension and relation of the osseous thoracic vertebra canal （TVC） and its adjacent bony structures for further study of surgical approach. Methods The study was based on the data of Bony TVC and its adjacent bony structures which were observed and measured on 15 dry thoracic spine（TS）. CT scans of six wet adult cadaveric TS specimens were obtained. The exposure area and angle of view were observed after the lateral structure of thoracic vertebra were removed. Efilm software was utilized to analyse the data. Results The TVC was relative narrow. The superior articular process （SAP） was v-shaped from superior- posterior view. The distance between left and right SAP of T1 was the broadest and T5 ,T6 was the most narrow level. The transverse process extended posteriorly and formed an angle with the median sagittal plane, which decreased from T1 to T10. It was these after the removal of the lateral bony structure which simulated with the different surgical approach, the view of angle exposing the vental part of the TVC of the lateral-anterior approach was larger, which increased 20° than the trans- pedicle trans-articular approach. Conclusions It was difficult to expose its ventral part via posterior approach. The pedicle, transverse process and little segment of the adjacent rib were the primary bony obstacle to the ventral TVC. The lateral-anterior approach was an alternative approach for the ventral mass of the thoracic spine.