Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
J Neurosurg Spine. 2010 Sep;13(3):346-50. doi: 10.3171/2010.3.SPINE09814.
Surgical approaches to the upper anterior thoracic spine can be a challenge. Various techniques such as transsternal routes have been employed but access to the midthoracic vertebrae is limited due to the position of the heart and great vessels. In the present study the authors' goal was to evaluate in cadavers a novel approach to the upper anterior thoracic spine.
In 12 adult cadavers the majority of the left first rib was removed following infraclavicular transection of the attachment of the anterior and middle scalene muscles from this bone. Inferior retraction of the parietal pleura and lung was performed and dissection was carried out inferior to the left subclavian artery and superior and posterior to the aorta, to the anterior aspect of the upper thoracic spine.
The aforementioned approach and surgical corridor allowed a good access to the anterior aspect of the upper thoracic vertebrae and caudally to the inferior aspect of T-4 vertebral body in all cadavers. No obvious neurovascular injury was identified in any specimen.
To the authors' knowledge, the method described herein has not been previously reported. Based on their cadaveric study, they believe such an approach can be used in the patients with pathology in this region of the thoracic spine. Surgical series are now needed to confirm our findings.
上胸前路的手术入路颇具挑战。尽管有经胸骨途径等多种技术，但由于心脏和大血管的位置，中胸椎的显露仍受限制。本研究旨在评估一种新的上胸前路入路在尸体标本中的效果。
在 12 具成人尸体标本中，从该骨的锁骨下切断前、中斜角肌附着处，切除大部分左侧第一肋骨。向下牵拉壁层胸膜和肺，在左锁骨下动脉下方、主动脉上方和后方进行解剖，到达上胸椎的前方。
上述入路和手术通道在所有标本中均提供了良好的上胸椎前方和 T4 椎体下表面的显露。在任何标本中均未发现明显的神经血管损伤。
据作者所知，目前尚未有文献报道过这种方法。基于尸体研究，作者认为这种方法可用于该胸段脊柱病变患者。目前需要外科系列研究来证实我们的发现。
