Applied Anatomic And Clinical Study Of The Modified Subscapularis Approach To The Upper Thoracic Spine

BackgroundUpper thoracic spine include 1^st to 4^th thoracic vertebrae(T₁-T₄).Because of complicating anatomical structure around the upper thoracic spine and the deep position of it,it is difficult to explode the spine.As reported,about 15%of tumor of spine and 0.3%calcification of posterior longitudinal ligament and intervertebral disk hernia happen in upper thoracic spine,and it always needs operations to deal with,as the result of the narrow vertebral canal.Because of the complicating anatomical structure,the approach to upper thoracic vertebrae is multiformity,such as the approach of splitting sternum,the approach of endoscope and so on.But the complications and the insufficiency of exploding range do not make us satisfied with them.In contrast,modified subscapularis approach to the upper thoracic spine could supply sufficiency of exploding range,leading to little complication.But there are some one reporting the injury of thoracic duct.So we do the anatomic research to get anatomic data about the modified approach and the clinical research to get the clinical data including indication,curative effect and experience.Objective:1.To provide anatomical data for the modified subscapularis approach to the upper thoracic spine.2.To get the clinical data of modified subscapularis approach to the upper thoracic spine including indication,curative effect and experience.Material and methods:Twenty-one upper thoracic spine specimens of adult human cadaver were divided randomly into three groups according to the costal incision,Right high-Left low,Right low-Left high and low incision groups.The specimens were exposed, measured and studied for their anatomy landmark according to the approach.The anatomic data of incision,exposed range,sympathetic nerve,arch of azygos vein and thoracic duct was measured and analyzed.The data is analyzed by SPSS 11.5 which is supplied by statistics department of South Medical University.Results:1.By this approach,the length of skin incision was(22.88±1.70)cm.And we could get a incision with(6.10±0.68)cm in width by removing part of 3^rd rid,exposing T₂ -T₄(100%).In addition,when the 2^nd or 4^th rid was removed partly at the same time, the width would be(8.08±0.93)cm or(8.87±0.73)cm,providing a sufficient exposure of part of T₁-T₄(85.7%) or T₂-T₅(100%).Removing the 4^th rid only,the width of incision would be(6.03±0.53)cm,exposing T₃-T₅(100%).The sympathetic nerve,arch of azygos vein and thoracic duct were exposed by this approach,and we could avoid injuring them by dissecting carefully.2.All of the cases have symptom releasing and sign improving,without serious complications.The imaging data show that the positions of bone graft and internal fixation are satisfy.Conclusion:1.The modified subscapularis approach to the upper thoracic spine can be applied to deal with most of disease of the upper thoracic spine. 2.The modified subscapularis approach to the upper thoracic spine is safe and effective.