Applied Anatomy Of Subclavian Muscle In Surgical Treatment Of Proximal Clavicular Malignant Tumor And Its Clinical Significance

Objective: to investigate whether subclavian muscle has a barrier effect on the growth of malignant tumor of proximal clavicle through applied anatomy andimaging study of proximal clavicle region,and if so,what is the range of barrier.Within this barrier,if the malignant tumor of the proximal clavicle can be resectedat R0.Methods: 1.By dissecting 7 adult specimens(6 males and 1 female),14 adult specimens were fixed with formaldehyde solution.the important structure of the proximal clavicular region and the position and starting and ending point of the subclavian muscle were observed,and the related data of the subclavian muscle were measured.2.The clavicle,subclavian muscle and subclavian vein were rec-onstructed by mimics software.the reconstructed images were compared with CTimages,and the position of subclavian muscle was analyzed.The projection area of clavicle in subclavian vein and the ratio of subclavian muscle to projection are a were calculated,and the intersection index of internal and external edge of the three overlapping areas was calculated.(the intersection index is the distance betwe en the medial and lateral edges and the sternoclavicular joint divided by the length of the clavicle and multiplied by 100).4.The clinical data of 6 cases of proxy-mal clavicular malignant tumor were analyzed retrospectively to determine whethe r R0 resection could be achieved.Results: 1.In anatomy,the subclavian muscle ori ginated from the first rib,lateral to the sternoclavicular joint,ended at 1/3 at t-he outer part of the clavicle,and partly at the anteromedial margin of the coracoid.The subclavian muscle has two positions: the posterior subclavian muscle(12/14)and the posterior clavicular muscle(2/14),which walk between the clavicle an-dthe subclavian vein and play a barrier role in the growth of malignant tumorsatt he proximal end of the clavicle.2.In the imaging and reconstruction studies,the subclavian muscle also had two positions: the posterior subclavian muscle(28/34)and the posterior clavicular muscle(4/34),and the subclavianmuscle was absent in2 sides(2/34).3.When the subclavian muscle was located behind and below the clavicle,the ratio of the projection area of the subclavianmuscle to the projection area of the subclavian vein was 43.93±11.36%(25.61%~67.44%).4.Among 6 cases,3 cases were negative after operation,the other 3 cases were not reported after operation,1 case of osteosarcoma was lost 9 months after operation,and the remaining 5 patients were not found local recurrence and distant metastasis duringfollow-up.Conclusion: when the subclavian muscle is located behind and below the clavicle,it passes through the projection area of the subclavianvein and plays an effective barrier role for the malignant tumor of the proximal clavicle to invad e the subclavian vein.if the tumor does not invade the subclavian vascular nerve bundle,The malignant tumor of proximal clavicle can be resected by R0.