| objective：to provide anatomical basis for clinical application,the anatomicrelationship between the thoracic vertebrae and adjacent structure inmidaxillary line-thoracic approach was investigated and variousrelevant anatomy data was measured.Material and methods：10fixed adult cadavers(thoracic wall and upper limb complete)were included in this Study. The specimens were exposed，measuredand studied for their anatomy landmark according to the approach. Theanatomic data of incision，exposed range，sympathetic nerve，arch ofazygos vein and thoracic duct was measured and analyzed and the datawere processed with the SPSS16．0．Results:1. the length of skin incision was: the mean of left（11.79±0.84）cm, the mean of right（11.47±0.16）cm; by removing part of the thirdrid, the width of incision was: the mean of left（6.95±0.52）cm, the mean of right（7.12±0.42）cm.2. the relative level position between the cranial of the approachand vertebrae:80%locates under a third of the T2level; The relative levelposition between the caudal of the approach and vertebrae:60.0%locates at one third of the T5.3.the distance between the nailing point of T1and the superiorborder is: the mean of left（9.32±1.40）cm, the mean of right（8.79±0.87）cm; the angle between the nailing point of T1and the superior border is:the mean of left（8.25±0.76）°, the mean of right（7.82±0.51）°,.thedistance between the nailing point of T6and the inferior border is: themean of lef（t12.08±0.69）cm, the mean of righ（t11.79±0.72）cm; the anglebetween the nailing point of T6and the inferior border is: the mean ofright（9.25±0.72）°, the mean of right（9.51±0.48）°.4.the relative level position between the superior edge of the aortaarch and vertebrae:70%locates at T3level; the relative level positionbetween the arch of azygos vein and vertebrae:60.0%locates at T4level; the relative level position between the thoracic duct andvertebrae:70.0%across the front of the T5.5. the distance between thoracic sympathetic trunk and the first tofourth joint of costal head: the first joint of costal head is: the mean ofleft（7.16±0.45）mm, the mean of right（6.51±0.65）mm；the secondjoint of costal head is: the mean of left（7.18±0.63）mm, the mean ofrigh（t6.80±0.38）mm；the third joint of costal head is: the mean of left（7.19±0.62）mm, the mean of righ（t6.79±0.49）mm；the fourth jointof costal head is: the mean of left（6.95±0.52）mm, the mean of right（7.13±0.42）mm. 6.the distance between the back of mediastinum and the lateralborder of the second to fifth joint of costal head: the second joint ofcostal head is: the mean of left（0.79±0.10）mm, the mean of right（1.67±0.09）mm；the third joint of costal head is: the mean of left（1.98±0.13）mm, the mean of right（2.31±0.14）mm；the fourth jointof costal head is: the mean of left（2.49±0.09）mm, the mean of right（2.79±0.07）mm; the fifth joint of costal head is: the mean of left（2.50±0.08）mm, the mean of right（2.56±0.07）mm.Conclusion：midaxillary line-thoracic approach could be used for exposure of theupper thoracic spine from T2to T5on the basis of various relevantanatomy measurement and data. Meanwhile, it has a number ofadvantages: satisfactory lateral decompression, fusion with bone graftand the placement of internal fixation, less invasion, safe surgicalprocedure and less complications. From the perspective ofanatomy,this approach is safe and feasible. |
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