Lester B, Jeong G K, Weiland A J, Wickiewicz T L
Department of Orthopaedic Surgery Montefiore Medical Center, Bronx, New York, USA.
Am J Orthop (Belle Mead NJ). 1999 Dec;28(12):718-22, 725.
Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.
四边孔综合征是一种罕见的、最近才被确认的神经血管压迫综合征，影响年轻的活跃成年人。患有这种综合征时，由旋肱后动脉（PHCA）和腋神经组成的神经血管束在穿过四边孔时被纤维带压迫。症状是由腋神经受压引起的，而非旋肱后动脉闭塞所致。由于四边孔综合征患者的临床表现模糊，往往不具有特异性，诊断具有挑战性，需要骨科医生高度怀疑。锁骨下动脉造影可确诊。治疗通常是保守的；手术治疗仅适用于特定患者。建议采用后入路，分离三角肌和小圆肌，以进行手术减压和松解纤维组织。我们报告了两例年轻成年人持续性四边孔综合征的病例，均接受了手术治疗，并进行了2年的随访。在本报告中，还对诊断标准、病理学、治疗、手术技术及近期文献进行了综述。
