Discussion Of Surgical Procedure To Upper Thoracic Spine

Objective:To investigate the effects and the anatomic relationship of the middle and anterolateral surgical approach of upper thoracic spine,and to provide reference for the thoracic surgical approach by comparing the advantages and disadvantages of two approachesMethod:10 upper thoracic spine specimens of adult human cadaver were exposed,and simulation the two surgical approaches,measured and studied for their anatomic landmarks.The origin,course of the recurrent laryngeal nerve,thoracic duct and blood vessels and their relationship were measured and measured and analyzed.The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and comparedResult:the middle approach can be exposed from T2 vertebral body to T3/4 disc by visceral vascular sheath and sheath gap,Half of the specimens can be exposed to T3 vertebral body,there is no significant difference between exposed range around both sides of the gap,10 specimens in this study may reveal the body of T3～T5 vertebrae body by the right brachiocephalic trunk gap,and in the subscapular approach group we could exposing T3～T5(100%) by removing part of the 4rd rib,Removing the 3th rid only,exposing T2～T4(100%).When the 2nd or 4th rib was removed partly,providing a sufficient exposure of part of T1～T4(80%) or T2～T5(100%).The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 80%of the specimens and among them,60%of azygos vein through the right side of T4 vertebral body,70%of brachiocephalic vein forks corresponds to the level of T3 vertebra and below T3, the average distance from the right and left sides were no significant differences from the thoracic sympathetic trunk to the Leading edge of the first rib joint.Conclusion:Anterolateral surgical approach to upper thoracic spine have the disadvantages of major complications of multi-trauma,the middle surgical approach have advantages to the expose above the lower cervical and upper thoracic spine T3,the anterolateral surgical approach have advantages to the exposed T3 vertebra below,Two approaches have advantages and disadvantages for the operation of the upper thoracic spine.