Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, Brazil.
J Neurosurg Spine. 2011 Jul;15(1):38-47. doi: 10.3171/2011.3.SPINE10342. Epub 2011 Apr 15.
The purpose of this study was to present straightforward preoperative methods to define the need for manubriotomy in the anterior surgical approach to the cervicothoracic junction.
Preoperative MR imaging and CT scanning studies were performed in all patients. The CT images with sagittal reconstructions including the manubrium were done to apply the so-called surgeons' view line. This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc, and the decision concerning the need for manubriotomy depends on the correlation between this line and the manubrium.
Preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C-7 corpectomy or C7-T1 discectomy cases; nevertheless, manubriotomy was needed in half of the cases when the T-1 corpectomy was the lowest level to be resected (8 cases), and in 4 cases the lowest level to be approached was T-2. The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy than in the manubriotomy group.
By using the surgeons' view line and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the use of preoperative evaluation of the need for manubriotomy as an aid to surgical planning and to give the patient and family realistic expectations about the surgery.
本研究旨在提出一种简单的术前方法，以确定颈胸交界处前路手术中是否需要行胸骨切开术。
所有患者均行术前 MRI 和 CT 扫描检查。对包括胸骨在内的 CT 图像进行矢状位重建，以应用所谓的“术者视图线”。该线与下一个健康上位椎体或突出椎间盘上位椎体的下关节面平行，是否需要行胸骨切开术取决于该线与胸骨之间的关系。
所有病例的术前胸骨切开术规划均正确。在 C-7 椎体切除术或 C7-T1 椎间盘切除术病例中，从未行胸骨切开术；然而，当 T-1 椎体切除术为最低切除水平时，有一半病例需要行胸骨切开术（8 例），有 4 例最低需要到达 T-2 椎体水平。与胸骨切开组相比，颈前入路组的手术时间、出血量、术后疼痛强度和住院时间均较少。
通过使用术者视图线及其与胸骨的相关性，可以在不影响减压和重建的情况下预测是否需要行胸骨切开术。胸骨切开术和颈前入路组手术变量之间观察到的统计学差异证明，术前评估胸骨切开术的必要性有助于手术规划，并使患者及其家属对手术有更现实的预期。
