本文選題：頸胸段 + 脊柱�。� 參考：《鄭州大學》2005年碩士論文

【摘要】：頸胸段脊柱是指頸椎和胸椎的移行部分,主要是指C_6-T_2四個椎體。對來自頸胸段脊髓前方的壓迫,需采用前入路手術直接顯露病變部位,以便減壓。頸胸段前方解剖結構復雜,顯露困難,目前尚無一種成熟理想的手術入路。作者1997年3月-2005年1月采用經(jīng)胸骨上段入路手術治療頸胸段脊髓壓迫癥患者16例,術野顯露充分,治療結果滿意。 資料與方法 本組16例,男11例,女5例;年齡33-67歲,病程10天-2年。病變部位:C_(6-7)、C_6-T_1、T_(1-2)、T_2和T_3各1例,C_73例,C_7-T_13例,T_15例。病變類型:骨折4例,骨折合并脫位6例,漿細胞瘤、結核、纖維脂肪血管瘤、肺癌轉移、食管癌轉移和不明原發(fā)病灶均1例。術前脊髓神經(jīng)功能按Frankel分級:A級2例均為骨折;B級4例:不明原發(fā)病灶和漿細胞瘤各1例,骨折2例;C級6例:轉移性肺癌、轉移性食管癌和結核各1例,骨折脫位3例;D級4例:纖維脂肪血管瘤1例。骨折脫位3例。14例伴括約肌功能障礙。 患者均有不同程度的頸胸背部疼痛,局部有壓痛、扣擊痛和頸胸段脊柱活動受限。1例左側肩部、前臂疼痛、麻木,1例雙肩痛并向雙上肢放射,1例雙上肢麻木,1例中、環(huán)和小指麻木,4例乳頭以下麻木、感覺減退、雙下肢肌力減弱(Ⅰ-Ⅳ級)和雙膝腱發(fā)射亢進,1例乳頭以下運動、感覺完全喪失。3例出現(xiàn)心動過緩(心率50-58bpm),1例出現(xiàn)低血壓,1例出現(xiàn)右側Horner征,1例合并應激性胃潰瘍、肺部感染和左小腿筋膜室綜合癥,1例合并食管癌伴肺轉移、左側胸腔積液和肺不張,1例合并胸膜鈣化和冠心病(隱匿型),1例合并肺癌并縱隔淋巴結轉移。
[Abstract]:The cervical and thoracic spine refers to the transitional part of the cervical and thoracic vertebrae, mainly C6-T _ T _ 4 vertebrae. Anterior approach should be used to expose the lesion directly to decompress the anterior cervical and thoracic spinal cord. The anatomic structure of anterior cervical and thoracic segment is complex and difficult to expose, so there is not a mature and ideal surgical approach. From March 1997 to January 2005, 16 patients with cervical and thoracic spinal cord compression were treated by transsternal approach. The surgical field was fully exposed and the results were satisfactory. Materials and methods 16 cases, male 11, female 5, aged 33-67 years, the course of disease was 10 days-2 years. The lesion site: C _ (6-7) / C _ 6-T _ (1) T _ (1-2) T _ (2) T _ (2) and T _ 3 (n = 1) respectively; There were 4 cases of fracture, 6 cases of fracture with dislocation, 1 case of plasmacytoma, 1 case of tuberculosis, 1 case of fibrous adipose hemangioma, 1 case of metastasis of lung cancer, 1 case of metastasis of esophageal carcinoma and unknown primary lesion. According to Frankel grade, 2 cases of spinal cord nerve function were classified as fracture B grade 4 cases: 1 case with unknown primary lesion and 1 case with plasmacytoma, 6 cases with fracture with grade C, 1 case with metastatic lung cancer, 1 case with metastatic esophageal carcinoma and 1 case with tuberculosis. 3 cases of fracture and dislocation 4 cases of D grade: 1 case of fibrous adipose hemangioma. 3 cases with fracture and dislocation. 14 cases with sphincter dysfunction. All the patients suffered from neck, chest and back pain, local tenderness, clasping pain and limited movement of the cervical and thoracic spine in 1 case, left shoulder pain, forearm pain, numbness in 1 case, double shoulder pain and radiation to both upper limbs in 1 case, in which 1 case had bilateral upper limb numbness, 1 case had pain in the left shoulder, 1 case had numbness in the forearm, and 1 case had bilateral upper limb numbness. Ring and finger numbness were found in 4 cases with subnipple numbness, hypoaesthesia, lower limb muscle strength (grade 鈪，

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