摘要
目的研究一种新的锁骨上入路微创治疗胸廓出口综合征的解剖学基础及模拟手术。方法在5具10侧成人甲醛浸泡标本逐层解剖颈外侧区及颈前区,依据其解剖特点确定内窥镜手术入路及手术操作平面,测量入路点至颈横动脉的距离。在1具双侧人体标本上模拟内窥镜手术,观察组织层次及探查松解臂丛神经。结果胸锁乳突肌胸骨头至乳突长度为(13.78±0.94)cm,胸锁乳突肌后缘与臂丛颈5神经根上缘交界处距离胸骨头长度为(7.79±0.60)cm,臂丛颈5神经根上缘至胸骨头的距离占胸锁乳突肌全长比例为(56.58±2.78)%。解剖研究表明最佳手术入路点为胸骨头至乳突全长60%处,头偏向健侧60°,纵行切开1 cm。以该切口于新鲜人体标本进行模拟手术操作,颈横动脉为镜下标志性解剖结构。结论锁骨上入路内窥镜微创治疗胸廓出口综合征可行性高,可清晰暴露臂丛神经,进行臂丛神经松解操作,有临床应用价值。
ObjectiveTo explore the anatomical basis and simulated operation of a new minimally invasive treatment for thoracic outlet syndrome(TOS)through supraclavicular approach.MethodsLocal dissection in both sides was performed at lateral and anterior neck region in 5 cadavers.The endoscopic approach and operative plane were determined according to their anatomical characteristics,and the distance from the approach point to the transverse cervical artery was measured.Endoscopic surgery was simulated on a fresh cadaver to observe the tissue level and perform the release of brachial plexus.ResultsThe distance between sternum head of sternocleidomastoid muscle and mastoid process was(13.78±0.94)cm.The distance between the cross border of the posterior border of sternocleidomastoid muscle and the upper border of the 5th root of brachial plexus and sternal head was measured(7.79±0.60)cm,which account for(56.58±2.78)%of the total length of sternocleidomastoid muscle.The anatomical study showed the optimum surgical entrance point:60%of the total length of sternal head to mastoid process,60°to the healthy side of the head,and 1 cm of longitudinal incision.The incision was performed on fresh human specimens and the transverse cervical artery was the landmark anatomical structure under the endoscope.ConclusionSupraclavicular approach endoscopic minimally invasive treatment for TOS is feasible,which can clearly expose brachial plexus nerve to perform brachial plexus neurolysis operation.It has clinical application value.
作者
张轩
庄永青
劳杰
熊洪涛
魏瑞鸿
刘英男
温桂芬
徐涛
刘兆康
陈纯玲
Zhang Xuan;Zhuang Yongqing;Lao Jie;Xiong Hongtao;Wei Ruihong;Liu Yingnan;Wen Guifen;Xu Tao;Liu Zhaokang;Chen Chunling(Department of Hand Microsurgery,People's Hospital of Shenzhen Affiliated to the Second Clinical Medical College of Jinan University,Guangdong 518020,China;Department of Hand Surgery,Huashan Hospital,Fudan University, Shanghai 200040,China)
出处
《中华手外科杂志》
CSCD
北大核心
2019年第1期30-33,共4页
Chinese Journal of Hand Surgery
基金
深圳市科研项目(JCYJ20140416122811970)
深圳市三名工程项目(SZSM201512032).
关键词
胸廓出口综合征
解剖
内窥镜
手术入路
Thoracic outlet syndrome
Dissection
Endoscopes
Surgical approach
