Anterior approach and hemisectomy of stern for upper thoracic disease

English Keywords:Upper thoracic disease  Upper stern hemisectomy  Approach

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcome of anterior approach and hemisectomy of stern for upper thoracic disease. Methods: 17 patients suffering from upper thoracic lesions underwent anterior hemisectomy of stern from July 2005 to September 2010. There were 8 males and 9 females with the age ranging from 27 to 77 years, with an average age of 57.7 years. The pathogenesis included T3 aneurysmal bone cyst in two cases, T2-T3 tuberculosis in seven cases, T3-T4 tuberculosis in three cases, T2 bone giant cell tumor in two cases, T3 giant cell tumor in two cases and T2 chondrosarcoma in one case. Before operation, upper thoracic sagittal CT was analyzed with the aim to determine the scope of surgery. Upper sternum was resected and removed as half-moon. Both sides of the sternoclavicular ligament were retained. Through the window of the brachiocephalic artery, lesion was exposed. The debridement or excision, bone grafting or reconstruction of internal fixation were performed afterward. Intraoperative, postoperative and follow-up complications were recorded. Results: 17 patients were perfomed surgery successfully. All lesions were exposed satisfactorily. Three cases were complicated with bradycardia, low blood pressure or increase of airway resistance during operation, and all resolved quickly after the discharge of traction. 1 case was complicated with transient hoarseness, that was resolved 2 month later. The surgical time was 2-3h, and the amount of blood loss was 200-700ml, averaging 400ml. All patients were followed up for 17-27 months, with an average of 22.7 months. No fixation failure was noted, and all cases reached bony fusion. Physiological curvature of the cervical and thoracic segment recovered. 17 cases with preoperative neurological deficit recovered partially. Conclusions: The modified upper thoracic vertebral approach can effectively expose T2-T4, which can retain the sternoclavicular joint and sternum, and is proved to be an ideal approach for managing upper thoracic lesions.