劈胸骨柄同时锁骨离断T2、T3前入路应用解剖学研究

目的　探索安全显露和处理T2、T3椎体的理想前入路方式。 方法 对30例（60侧）经福尔马林固定、红色乳胶灌注的成人尸体标本采用劈胸骨柄同时锁骨部分切断术模拟脊柱T2、T3椎体前入路手术。在该入路中，寻找不同的间隙，暴露可能的椎体节段。 结果　将左颈动脉鞘（左颈总动脉、左颈内静脉、左迷走神经及其颈心支）、左锁骨下动脉、胸导管、颈交感干及左纵隔胸膜一起向外侧牵拉，向内侧牵拉气管、食管、左喉返神经及其分支，向下牵拉左头臂静脉的方式，30例标本均能清楚的显露T1上缘至T3下缘，部分（6例）可达T4中部。 结论　劈胸骨柄和锁骨部分切断入路中，可找到一种显露和处理　T2、T3椎体的安全间隙方法。

Applied anatomy of the anterior approach to 2nd and 3rd thoracic vertebral bodies with osteotomy of the clavicle and partial median sternotomy

Objective To explore an ideal method of exposing and treating 2nd and 3rd thoracic vertebral bodies.Methods 30 adult embalmed cadavers(50 sides) were selected and observed.By modeling the anterior approach,the 2nd and 3rd thoracic vertebral bodies were exposed and treated through dissecting a safe space among superior edge of the aortic arch,left subclavian artery,left common carotid,brachiocephalic trunk and brachiocephalic veins.Results Under the standard left anterior approach combined with osteotomy of the clavicle and partial median sternotomy,through the synostosis between the manubrium and body of the sternum,a safe space can be acquired: left carotid sheath(common carotid,internal jugular vein,vagus nerve and its branches),thoracic duct,truncus sympathicus cervicalis,and left pleura mediastinalis were pulled towards lateral;trachea,esophagus,and left recurrent laryngeal nerve were pulled towards internal;left brachiocephalic vein was pulled towards inferior.T1-T3 can be easily exposed on the total 30 adult human cadavers and T4 also can be observed on partial cases.Conclusions Adequate exposure of 2nd and 3rd thoracic vertibral bodies can be obtained by the above approach.It provides adequate work room for treating them.