肩胛下高位经胸入路行上胸椎前路减压融合术

目的探讨前路肩胛下高位经胸入路行上胸椎减压内固定的显露效果。方法本组 8例 ,男 6例 ,女 2例 ,年龄2 6 - 5 5岁 ,平均 37岁。病变范围胸3 ～胸5椎体 ,其中胸3 ,4结核 3例 ,胸3 ～胸5转移性肿瘤 3例 ,胸4,5骨折 2例。采用肩胛下高位经胸入路显露胸1～胸5椎体 ,结核行病灶清除 ;肿瘤行病椎切除 ,骨水泥充填 ,Z -plate内固定 ;骨折行侧前方减压、植骨、Z -plate内固定。结果 8例均良好地显露出胸1～胸5椎体 ,并完成病灶清除、减压、内固定 ,无重要血管神经损伤 ,无 1例出现神经症状加重 ,伤口均一期愈合 ,仅 1例发生胸导管损伤 ,经对症治疗 1周后痊愈。结论肩胛下高位经胸入路是显露上胸椎较理想的入路 ,便于行侧前方减压 ,并有充分的空间行内固定。

The high transthoracic approach for anterior decompression and instrumentation of the upper thoracic vertebrae

Objective To study the exposure of the high transthoracic approach for anterior decompression and instrumentation at the upper thoracic vertebrae.Methods There were eight patients, six male and two female. The age was 26 to 55 years old with average of 37 years old. The lesion involved T₃ to T₅ vertebrae with T_3,4 tuberculosis involves in three patientsT₃~T₅ metastatic tumor in three patients,and T_4,5 fracture in two patients. All patients operation through high transthoracic approach. Lesion clearance was performed for tuberculosis. Vertebrectomy followed by bone cement and Z-plate was undergone for metastatic tumor. Anterior decompression and fusion followed by Z-plate was undergone for vertebrae fracture.Results Successful exposure, lesion clearance, or decompression and implant were made in all eight patients. The were no important vascular and nerve injury, no wound infection. One patient had thoracic duct injury and was cured one week postoperatively. Conclusion The high transthoracic approach to the upper thoracic vertebrae was a favorable way. The approach provide a better visualization and enough space for anterior decompression and implant.