Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Institute of Anatomy II, University of Cologne, Cologne, Germany.
Surg Radiol Anat. 2020 Aug;42(8):961-968. doi: 10.1007/s00276-020-02446-2. Epub 2020 Mar 3.
Anterior surgical approaches to the thoracic spine are common procedures for the treatment of many diseases of the thoracic spine. Purpose of this anatomic study is to investigate the course of the segmental vessels of the thoracic spine for the anterior and lateral transthoracic approach from the right side.
26 formalin-fixed human cadavers (20 femaless/6 male) with an average age of 84.9 ± 8.3 (range 67-97) were included. The segmental arteries and veins of the right thoracic cavity coursing between the third and twelfth thoracic vertebral body have been investigated. To define the localization of the vessels in accordance with the associated vertebral bodies, the distance between the endplates and vessels was measured in the ventral, middle and dorsal parts.
The results of the study reveal that not only one, but also two segmental arteries and veins may course over the right hemi-vertebral body, especially in the upper and middle thoracic spine. Furthermore, in the middle and lower thoracic spine (T7-T12) the vessels course over the middle and lower third of the craniocaudal extent of the vertebral body. On the contrary, in the upper thoracic spine (T3-T6), the vessels may course over the entire extent of the vertebral body.
Due to these common anatomic variations and variability of the course of the segmental vessels, spinal surgeons should remain careful in the identification of the segmental vessels in order to minimize risk of vascular injury in case of right-sided anterior and lateral approach to the thoracic spine.
胸腰椎前路手术是治疗许多胸腰椎疾病的常用方法。本解剖研究的目的是从右侧研究胸段前路和侧前路经胸入路的节段血管走行。
纳入 26 具福尔马林固定的人体尸体（女性 20 具/男性 6 具），平均年龄 84.9±8.3（67-97 岁）。研究了右侧胸腔内第三至第十二胸椎体之间的节段动脉和静脉。为了根据相关的椎体来确定血管的定位，在腹侧、中侧和背侧测量了血管与终板之间的距离。
研究结果表明，不仅有一条，而且有两条节段动脉和静脉可能越过右半椎体，特别是在上胸段和中胸段。此外，在中胸段和下胸段（T7-T12），血管位于椎体的中下部。相反，在上胸段（T3-T6），血管可能越过整个椎体。
由于这些常见的解剖变异和节段血管的走行变异，脊柱外科医生在识别节段血管时应保持谨慎，以尽量减少右侧前路和侧前路入路治疗胸腰椎时发生血管损伤的风险。
