| Background and Objective: Cervicothoracic junction usually includes the region from C7-T3,may also from expansively C6 to T4.It is located between the junction of cervical anterior lordosis and thoracic kyphosis, the important great blood vessels surround it, and important nerves distribute intensively, so that the cervicothoracic junction is called the most hardest region of"Three hard regions of approach of spinal surgery."The traditional surgery approach owns many disadvantages. Such as surgical field isn't good, the incision is long, recovery slow ,and more complications et al. This study is to probing into the possibility and safety of anterior approach of cervicohoracic junction with video-assisted technique surgery(VATS)with an assistant small incision.Material and method20 complete native adults corpses are selected as anatomic material.(including 16 male and 4 female),mean height is 163cm.(1)The head goes toward right and little bit bias, incision begins from the position 3cm above manubrium sterni superior notch, with a Robision-Smith incision, combining anterior incision on the midline of superior part of manubrium sterni. Cut open subcutaneous tissue and the platysma ,cut off sternohyoid, sternothyroid, omohoid muscles. A blunt dissection of the posterior face of the manubrium is performed with fingers. (2)Expose the upper vertebrae at the space between left carotid artery and trachea-esophagus sheath. Dissect subcutaneous tissue, and expose left, right second rib space. At left and right second rib space near to sternal can be inserted each 1cm trocar. (3)Replace manubrium superior notch with a nail top(Make a long nail into the inferior vertebrea), saw open all ribs in midaxillary line, then uncover chest wall.(4)Measure the related important anatomic structures and the data of correlations.(5)All results are made statistical analysis with SPSS 12.0.(6) Build up a cervicothoracic anatomic mathematic model about anterior VATS technique.Result1. The mid-point of manubrium sterni superior notch (Point A)is mostly located at T2 inferior 1/3(30%), and T2/3 disc(35%) level. 2. Point O between both roots of left brachiocephalic trunk and left carotid artery most ly often be located at T3 inferior 1/3(55%). 3.The superior intersection of central axis and left brachiocephalic vein(point P1) most often be located at T3 superior 1/3(65%).The lower intersection (Point P2) is commonly located at T3 inferior 1/3(55%). 4. Distance AB between the mid-point of manubrium sterni superior notch (Point A) and the mid-point of C7(point B) is 50.05±10.03mm. Distance AC between the mid-point of manubrium sterni superior notch (Point A) and the mid-point of T1(point C) is 44.62±6.86mm. Distance AD between the mid-point of manubrium sterni superior notch (Point A) and the mid-piont of T2(point D) is 48.51±9.18mm. Distance AE between the mid-point of manubrium sterni superior notch (Point A) and the mid-point of T1(point E) is 58.91±11.27mm. Distance AS between the mid-point of manubrium sterni superior notch (Point A) and the mid-point of second rib space (point S) is 67.25±9.87mm. 5. At dorsal position , included angle between anterior border of C7 and horizontal line(α) is 15.1±0.3°; included angle between anterior border of T1 and horizontal line(β) is 30.6±1.6°; included angle between anterior border of T2 and horizontal line(γ) is 30.3±1.2°; included angle between anterior border of T3 and horizontal line(θ) is 30.2±0.8°. 6. Longitude of the operation district is 67.25±9.97mm; width of it is 38.56±6.95mm; depth of it is 34.63±6.68mm. 7. Height of C7 is 19.34±2.17mm; width is 28.00±2.94mm;depth is19.20±2.95mm Height of T1 is20.60±2.02mm;width is 30.85±2.76mm;depth is20.05±2.59mm. Height of T2 is 20.21±1.96mm;width is 28.70±2.63mm ; depth is20.48±1.58mm. Height of T3 is 19.62±1.87mm;width is 26.96±2.82mm;depth is21.07±1.36mm.T1 vertebra is the tallest one,T2 vertebra is the widest one,T3 vertebra is the most deep one.C7 is an oval,T3 is the heart form,T1,T2 belong to transition vertebral bodies. 8. Distance between internal thoracic artery (or vein )and stenum margin LA1:8.40±5.08mm,LA2:10.21±2.91mm;LV1:5.85±5.29mm,LV2:8.58±3.00mm;RA1:8.41±5.79mm,RA2:10.49±2.61mm;RV1:5.58±5.38mm,RV2:9.06±3.13mm. 9.Width of the second space (WI) is 23.52±3.16mm. 10. Leaf cupula of pleura is 21.71±4.19mm above middle interior 1/3 of left clavicle. Right cupula of pleura is 22.78±4.61mm above middle interior 1/3 of right clavicle.Conclusion1.It is safe and feasible for anterior crvicothoracic operation using video-assisted technique surgery(VATS)with an assistant small incision, with sternal no-splitting or spilitting.2.Video-assisted technique surgery(VATS)with an assistant small incision with sternal no-splitting commonly can expose C6-T3 anterior aspect. Video-assisted technique surgery(VATS)with an assistant small incision with sternal splitting commonly can expose C6-T4 anterior aspect.3.It is more suitable to insert 1cm trocar in 2nd rib space than in 1st rib space in cervicothoracic anterior approach with VATS with assistant small incision. |
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