【作者】 李兴国；

【导师】 李兴国； 刘宗良；

【作者基本信息】 昆明医学院 ， 人体解剖与组织胚胎学， 2007， 硕士

【摘要】 目的探索一种安全暴露颈胸段椎体的最佳手术方式。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颈胸联合切口，胸骨柄和锁骨部分切断术模拟脊柱颈胸段椎体前入路手术。对该入路中主要结构采用不同的牵拉分离方式，在主动脉弓上缘、左锁骨下动脉、左颈总动脉、头臂干、左右头臂静脉之间分离出一个安全的“间隙”，充分暴露脊柱T1—T3椎体节段。结果经左侧颈胸联合切口、胸骨柄和锁骨部分切断，将左颈动脉鞘（颈总动脉、左颈内静脉、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，可清楚的显露T1上缘至T3下缘。结论经左侧颈胸联合切口、胸骨柄和锁骨部分切断，可为临床提供一种安全暴露颈胸段椎体的方法。[摘要]目的探索一种准确置入下颈椎椎弓根螺钉的定位定向方法。方法：对25例（50侧）经福尔马林固定、红色乳胶灌注的成人尸体标本C₃—C₇节段的颈椎侧块和椎弓根进行解剖、观测。结果1)以横突后结节基部上下缘中点横切面作为确定下颈椎椎弓根螺钉进钉点上下位置的标志。2)以上下关节突间侧凹外缘作为确定下颈椎椎弓根螺钉进钉点内外位置的标志。3)以横突后结节基部与下关节突前外侧缘之间的“三角形”小凹作为寻找椎弓根下缘的标志性结构。4)置入螺钉直径为下颈椎椎弓根狭部松质骨的横径。结论结果提供定位的标志性结构术中容易寻找，变异较小，定位准确，可为临床提供一种准确定位下颈椎椎弓根螺钉进钉点的方法。更多还原

【Abstract】 [Abstract] Objective To explore an optimal method of exposing thecervicothoracic junction（T1-T3） . Methods The anatomic relationship between the cervicothoracic junction and the adjacent tissue were observed on 30 adult embalmed cadavers （50 sides） by modeling the anterior approach to the cervicothoracic junction. T1-T3 vertebra can be exposed through dissecting a safe space among superior edge of the aortic arch, left subclavian artery, left common carotid, brachiocephalic trunk, left brachiocephalic vein and right brachiocephalic vein. Results A standard cervical left approach was combined with osteotomy of the clavicle and partial median sternotomy, which transverse osteotomy through the synostosis between the manubrium and body of the sternum, is the best optimal selection of exposing anterior aspect of the T1-T3 vertebra in all anterior approaches. A safe space can be dissected through this operational method: 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. The results of a study on 30 adult human cadavers showed that the anterior aspect of T1-T3 can be easily exposed through such the anterior approach to the cervicothoracic spinal junction. Conclusions Adequate exposure of the low cervical to the upper thoracic spine can be obtained with this approach. It provides adequate work room for inserting the screw into T1 and T3 vertebra. [Abstract] Objective To explore an accurate method of pedicle screw insertion in cervical vertebra（C₃-C₇） . Methods Anatomic morphology of lateral mass and pedicle, and their anatomic relationship with the adjacent were observed on C₃-C₇ segment of 25 adult embalmed cadavers （50 sides）. Results l)The inferior edge of the base of the posterior tubercle of the transverse process and the inferior edge of the pedicle were connected with each other on 25 adult embalmed cadaver （50 sides）; The transverse section which passed through the median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, and the transverse section which passed through the central axis between the superior edge and the inferior edge of the pedicle were in the same of horizontal plane. The superior and inferior position of the pedicle insertion was determined by this transverse section which passed through the median point between the superior and the inferior edge of the base of the posterior tubercle of the transverse process; 2) There was an internal-descending "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process. The wall of the triangular sulcule: the anterior wall was the base of the posterior tubercle of the transverse process; the posterior wall was the anterolateral edge of the inferior articular process; the bottom of the sulcule was connected with the interior edge of the pedicle. The vertical length between the top of triangle and the planes of inferior edge of the pedicle was （2．78±1．71） mm. The inferior edge of the cervical pedicle could be detected by a blunt touch needle along the "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process in surgical operation. 3) The lateral fovea of the articular process was observed on all lateral mass （50 sides）. The relation of the medial and lateral position was the lateral edge of the lateral fovea of the articular process. The horizontal length between the lateral fovea of the articular process and the point of pedicle screw insertion was （3．14±1．45） mm. 4) The diameter of pedicle screw, about （2．78±1．71） mm, was the transverse diameter of the cancellous bone of the narrow part of the cervical pedicle.. Conclusions The median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, the lateral fovea of the articular process, and the triangular sulcule between the base of the posterior tubercle of the transverse process and the anterolateral edge of inferior articular process, were easy to be exposed and identified in the surgical operation. Transpedicular screw can be precisely inserted through this method. The first and third points aforesaid in results were the first time reported.更多还原