【摘要】： 脊柱頸胸段疾病在脊柱外科領域占有重要地位,隨著外科治療理論和技術的不斷進步,外科手術日益成為脊柱頸胸段疾病的重要手段。對于脊柱疾病,尤其是脊柱頸胸段的手術顯露是脊柱外科的難點之一。脊柱頸胸椎段(C7—T3)處于頸椎前凸到胸椎后凸的移行部位,前有胸骨、縱隔阻擋,位置深在,前方重要的神經、血管及淋巴管縱橫交錯。臨床上引起脊髓壓迫的絕大部分病變如腫瘤、感染以及退行性病變等疾病都來自脊髓的前方,因此,脊柱手術入路的選擇也逐漸從后路減壓、后外側減壓轉向了前方手術入路直接減壓。但是,此處前方結構復雜,由于其解剖結構的特殊性,對累及C7—T3椎體的病變手術時顯露困難,容易損傷周圍的組織結構,增加了手術難度和風險。因此,有必要對其局部解剖結構進行深入研究。本論文從臨床分析和解剖學角度,探討脊柱頸胸段的術中顯露及如何避免并發(fā)癥,減少手術風險;強調右側喉返神經在經右側施行T1,2椎體手術時易受損傷,行左側入路手術時如熟悉胸導管的走行,可避免損傷,同時術中操作應注意避免頸交感干的損傷。本論文比較經不同的血管、神經間隙進行顯露及手術操作時的風險性和優(yōu)缺點,以減少并發(fā)癥,提高手術療效,為手術方案的設計提供參考。
[Abstract]:The disease of cervical and thoracic segment of spine plays an important role in the field of spinal surgery. With the development of surgical treatment theory and technology, surgical surgery has become an important means of cervical and thoracic spinal diseases. The surgical exposure of spinal diseases, especially the cervical and thoracic segments of the spine, is one of the most difficult points in spinal surgery. The cervical thoracic vertebrae (C7-T3) is located in the transitional position from the anterior cervical spine protruding to the thoracic kyphosis, with sternum, mediastinal obstruction, deep position, and crisscross of the important nerves, vessels and lymphatic vessels in the front. Most of the diseases that cause spinal cord compression clinically, such as tumors, infections and degenerative diseases, all come from the anterior side of the spinal cord. Posterolateral decompression shifted to direct decompression via the anterior approach. However, because of the particularity of the anatomical structure, it is difficult to expose the lesions involving C7-T3 vertebrae, and it is easy to damage the surrounding tissue structure, which increases the difficulty and risk of the operation. Therefore, it is necessary to study the local anatomical structure. From the angle of clinical analysis and anatomy, this paper discusses the intraoperative exposure of the cervical and thoracic segments of the spine and how to avoid complications and reduce the risk of surgery, and emphasizes that the right recurrent laryngeal nerve is vulnerable to injury during the operation of the right side of the T _ 1O _ 2 vertebra. If you are familiar with the thoracic catheter, the injury can be avoided during the operation of the left approach, and the injury of the sympathetic trunk of the neck should be avoided during the operation. In this paper, the risks, advantages and disadvantages of exposure and operation of different blood vessels and nerve spaces were compared to reduce complications, improve the curative effect and provide reference for the design of surgical scheme.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R687.3;R322

【參考文獻】

相關期刊論文 前5條

1 滕紅林,賈連順,肖建如,譚軍,劉鐵龍,魏海峰,王美豪;MRI測量頸胸角在選擇頸胸段脊柱手術入路中的臨床應用[J];中國骨傷;2004年06期

2 葉招明,嚴世貴,楊迪生,范順武,陶惠民,柴瑩;頸胸段脊柱腫瘤的外科治療[J];中華骨科雜志;2000年05期

3 葉曉健,賈連順,袁文,何海龍,李家順;改良Sundaresan法治療上胸椎腫瘤[J];中華骨科雜志;2004年08期

4 肖建如,賈連順,袁文,戴力揚,陳德玉,包聚良,趙定麟;上胸椎腫瘤的手術途徑及術式探討[J];中華外科雜志;2001年05期

5 肖嵩華,王巖,劉鄭生,劉保衛(wèi),張永剛,張西峰;經改良的上胸椎前方手術入路切除上胸椎椎體[J];中國矯形外科雜志;2003年13期

，

本文編號：2127728