[1]黄义星,王胜,池永龙,等.胸骨柄开窗显露脊柱颈胸段的影像学及解剖学研究[J].中医正骨,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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胸骨柄开窗显露脊柱颈胸段的影像学及解剖学研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期数:
2012年12期
页码:
7-10
栏目:
脊柱损伤
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:
黄义星; 王胜; 池永龙; 何家维
温州医学院附属第二医院,浙江 温州 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
关键词:
胸骨柄 颈椎 胸椎 可行性研究
Keywords:
Manubrium;  Cervical vertebrae;  Thoracic vertebrae;  Feasibility studies
摘要:
目的:探讨胸骨柄开窗法显露脊柱颈胸段的可行性。方法:选取120例行MRI检查者的颈椎MRI正中矢状面影像,男55例,女65例,年龄18～84岁,中位数49.5岁; 测量其颈静脉切迹和胸骨角平面向后平对的椎体或椎间隙水平。选取46例行胸部CT检查者的胸部薄层CT影像,男21例,女25例,年龄18～85岁,中位数50.5岁; 分别测量其颈静脉切迹、胸骨柄最宽和最窄部位的宽度以及后方对应椎体的宽度。同时在4具新鲜成人尸体标本上分别进行胸骨柄开窗显露脊柱颈胸段的模拟手术。结果:①胸骨柄与颈胸段椎体的解剖对应关系。120例被测试者颈静脉切迹对应的椎体均在T1以下,颈静脉切迹对应T2者44例,其中对应T2上1/3者10例,对应T2中1/3者16例,对应T2下1/3者18例; 对应T2～3椎间隙者27例; 对应T3者45例,其中对应T3上1/3者26例,对应T3中1/3者9例,对应T3下1/3者10例; 对应T3～4椎间隙及T4上1/3者各2例。120例被测试者胸骨角水平均低于T3,其中胸骨角对应T4者23例,对应T4～5椎间隙者31例,对应T5者66例。②胸骨柄宽度与对应椎体的宽度。46例被测试者颈静脉切迹宽度[(31.90±4.00)mm]大于对应椎体宽度[(26.70±2.70)mm](t=8.458,P=0.000),胸骨柄最宽部位宽度[(59.40±7.30)mm]大于对应椎体宽度[(26.20±2.60)mm](t=23.836,P=0.000),胸骨柄最窄部位宽度[(29.80±4.20)mm]大于对应椎体宽度[(25.60±2.50)mm](t=6.235,P=0.000)。③模拟手术。在4具新鲜尸体标本上的模拟手术均获得成功,可清楚显露脊柱颈胸段(C7～T3),甚至可以显露T4、T5椎体,并完成椎间盘切除、椎体次全切除、植骨以及钢板内固定等操作。结论:经胸骨柄开窗完全可以显露脊柱颈胸段,大多数情况下还可以显露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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备注/Memo

备注/Memo:
基金项目:国家自然科学青年基金项目(81101395),浙江省医药卫生科技计划项目(2011KYA110)
更新日期/Last Update: 2012-12-20