上位胸椎に対する前方進入法

Anterior Approaches to the Upper Thoracic Spine

　上位胸椎は，肋骨，胸骨，肩甲骨に囲まれ，心臓，肺，大血管が近接しているため，外科的進入が最も困難な部位である．37例の上位胸椎手術症例を検討した結果，胸骨縦割法は第1～3胸椎の後縦靱帯骨化症に，開胸法は，砂時計腫や第3胸椎以下に及ぶ病変に対して行われていた．再構築CT矢状断像は，上位胸椎進入法決定に必要な局所解剖（胸骨の位置，脊椎のアライメントなど）を把握するのに有用である．

　The upper thoracic spine region is difficult to access from an anterior approach because of the surrounding bones (ribs, sternum and scapulae) and organs (heart, lung and great vessels). The outcomes of 37 consecutive cases with lesions in the upper thoracic spine region (T1-4) were reviewed to study surgical approaches to the upper thoracic spine. We used anterior approaches in 13 cases. A full sternotomy was performed in 6 cases (5 cases：OPLL, 1 case：herniated disc), a high thoracotomy was performed in 6 cases (3 cases：herniated disc, 2 cases：spinal cord tumor, 1 case：TB spine), and a partial resection of a unilateral sternoclavicular joint was performed in 1 case. A sternotomy is thought to be useful for OPLL in the T1-3 region, whereas a high thoracotomy is recommended for unilateral anterior lesions and lesions extending below the T3/4 level. Reconstructive CT sagittal images can supply useful anatomical informations for selecting a surgical approach.