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[1]黃義星,王勝,池永龍,等.胸骨柄開窗顯露脊柱頸胸段的影像學(xué)及解剖學(xué)研究[J].中醫(yī)正骨,2012,24(12):7-10.
　HUANG Yi-xing*,WANG Sheng,CHI Yong-long,et al.Imaging and anatomical study on the effect of windowing of manubrium sterni on the exposure of cervicothoracic segments of spine[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2012,24(12):7-10.
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胸骨柄開窗顯露脊柱頸胸段的影像學(xué)及解剖學(xué)研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期數(shù):
2012年12期
頁(yè)碼:
7-10
欄目:
脊柱損傷
出版日期:
2012-12-20

文章信息/Info

Title:
Imaging and anatomical study on the effect of windowing of manubrium sterni on the exposure of cervicothoracic segments of spine
作者:
黃義星; 王勝; 池永龍; 何家維
溫州醫(yī)學(xué)院附屬第二醫(yī)院,浙江 溫州 325027
Author(s):
HUANG Yi-xing*; WANG Sheng; CHI Yong-long; HE Jia-wei.
*The Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China
關(guān)鍵詞:
胸骨柄 頸椎 胸椎 可行性研究
Keywords:
Manubrium;  Cervical vertebrae;  Thoracic vertebrae;  Feasibility studies
摘要:
目的:探討胸骨柄開窗法顯露脊柱頸胸段的可行性。方法:選取120例行MRI檢查者的頸椎MRI正中矢狀面影像,男55例,女65例,年齡18～84歲,中位數(shù)49.5歲; 測(cè)量其頸靜脈切跡和胸骨角平面向后平對(duì)的椎體或椎間隙水平。選取46例行胸部CT檢查者的胸部薄層CT影像,男21例,女25例,年齡18～85歲,中位數(shù)50.5歲; 分別測(cè)量其頸靜脈切跡、胸骨柄最寬和最窄部位的寬度以及后方對(duì)應(yīng)椎體的寬度。同時(shí)在4具新鮮成人尸體標(biāo)本上分別進(jìn)行胸骨柄開窗顯露脊柱頸胸段的模擬手術(shù)。結(jié)果:①胸骨柄與頸胸段椎體的解剖對(duì)應(yīng)關(guān)系。120例被測(cè)試者頸靜脈切跡對(duì)應(yīng)的椎體均在T1以下,頸靜脈切跡對(duì)應(yīng)T2者44例,其中對(duì)應(yīng)T2上1/3者10例,對(duì)應(yīng)T2中1/3者16例,對(duì)應(yīng)T2下1/3者18例; 對(duì)應(yīng)T2～3椎間隙者27例; 對(duì)應(yīng)T3者45例,其中對(duì)應(yīng)T3上1/3者26例,對(duì)應(yīng)T3中1/3者9例,對(duì)應(yīng)T3下1/3者10例; 對(duì)應(yīng)T3～4椎間隙及T4上1/3者各2例。120例被測(cè)試者胸骨角水平均低于T3,其中胸骨角對(duì)應(yīng)T4者23例,對(duì)應(yīng)T4～5椎間隙者31例,對(duì)應(yīng)T5者66例。②胸骨柄寬度與對(duì)應(yīng)椎體的寬度。46例被測(cè)試者頸靜脈切跡寬度[(31.90±4.00)mm]大于對(duì)應(yīng)椎體寬度[(26.70±2.70)mm](t=8.458,P=0.000),胸骨柄最寬部位寬度[(59.40±7.30)mm]大于對(duì)應(yīng)椎體寬度[(26.20±2.60)mm](t=23.836,P=0.000),胸骨柄最窄部位寬度[(29.80±4.20)mm]大于對(duì)應(yīng)椎體寬度[(25.60±2.50)mm](t=6.235,P=0.000)。③模擬手術(shù)。在4具新鮮尸體標(biāo)本上的模擬手術(shù)均獲得成功,可清楚顯露脊柱頸胸段(C7～T3),甚至可以顯露T4、T5椎體,并完成椎間盤切除、椎體次全切除、植骨以及鋼板內(nèi)固定等操作。結(jié)論:經(jīng)胸骨柄開窗完全可以顯露脊柱頸胸段,大多數(shù)情況下還可以顯露T4。
Abstract:
Objective:To explore the feasibility of exposure of cervicothoracic segments of spine through windowing of manubrium sterni.Methods:The median sagittal plane MRI images of cervical vertebra of 120 patients were selected from the MRI subjects,male 55 cases,while female 65 cases; ages from 18 to 84 years with a median of 49.5 years old; The level of vertebral body or intervertebral space which were flattened against the jugular incisure and sternal angle plane were measured.Forty-six CT images of chest were selected from the chest CT subjects,male 21 cases,while female 25 cases; ages from 18 to 85 years with a median of 50.5 years old.The jugular notch width,the maximal and minimal width of manubrium sterni and the width of rear corresponding vertebral body were measured respectively.Meanwhile,surgery simulation for exposing the cervicothoracic segments of spine through manubrium sterni fenestration were performed on 4 fresh adult cadaver respectively.Results:①Anatomical correspondence of manubrium sterni and vertebral body in cervicothoracic segments:the vertebral body corresponding to jugular notch for the 120 test subjects were all below T1 segment,and jugular notch corresponding to T2 segment were found in 44 cases,among which 10 cases corresponding to upper 1/3 of T2 segment,16 cases corresponding to medium 1/3 of T2 segment and 18 cases corresponding to lower 1/3 of T2 segment.The jugular notch corresponding to T2-3 intervertebral space were found in 27 cases and the jugular notch corresponding to T3 segment were found in 45 cases,among which 26 cases corresponding to upper 1/3 of T3 segment,9 cases corresponding to medium 1/3 of T3 segment and 10 cases corresponding to lower 1/3 of T3 segment.The jugular notch corresponding to T3-4 intervertebral space and the jugular notch corresponding to upper 1/3 of T4 segment were found in 2 cases respectively.The sternal angle levels were all lower than T3 segment in 120 test subjects,among which 23 cases corresponding to T4 segment,31 cases corresponding to T4-5 intervertebral space and 66 cases corresponding to T5 segment.②The width of manubrium sterni and its corresponding vertebral body:the jugular notch width[(31.90±4.00)mm]of 46 test subjects were all larger than those of their corresponding vertebral bodies[(26.70±2.70)mm](t=8.458,P=0.000); the maximal width[(59.40±7.30)mm]of manubrium sterni was larger than that of its corresponding vertebral body[(26.20±2.60)mm](t=23.836,P=0.000); the minimal width[(29.80±4.20)mm]of manubrium sterni was larger than that of its corresponding vertebral body[(25.60±2.50)mm](t=6.235,P=0.000).③Analogical surgery:the analogical surgery performed on the 4 fresh adult cadaver were all successful with clear exposure of cervicothoracic segment(from C7 to T3)and even T4 and T5 segment can be exposed.Furthermore,the following operations as discectomy,corpectomy,bone grafting and plates internal fixation were finished successfully.Conclusion:manubrium sterni fenestration can expose cervicothoracic segment of spine,and can even expose T4 segment in most cases.

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備注/Memo

備注/Memo:
基金項(xiàng)目:國(guó)家自然科學(xué)青年基金項(xiàng)目(81101395),浙江省醫(yī)藥衛(wèi)生科技計(jì)劃項(xiàng)目(2011KYA110)
更新日期/Last Update: 2012-12-20