Blanchard B, Blanchard G, Forcier P, Cloutier L G
Rev Med Suisse Romande. 1992 Mar;112(3):253-66.
There are 5 syndromes involving the thoracic outlet. The first four, although not well known, especially the first two, are authentic; they are: 1) arterial, due to a well formed cervical rib or to an incompletely formed first rib; 2) neurological, related to the fibrous band associated with a rudimentary cervical rib or a giant transverse process of C7; 3) venous, namely "effort thrombosis"; 4) late post-traumatic, secondary to a fracture of the clavicle. The study of these four syndromes prepares the reader to that of the controversial fifth syndrome, which is entirely subjective, made only of symptoms. The fifth syndrome, by very far the most frequent in the literature, called "scalenus anticus syndrome" in the past, now called "thoracic outlet syndrome" or "TOS" by North-American authors, has two varieties, one where hypotonic shoulder muscles, mostly in women, respond well to specific and simple exercises, and one where there is an accident in the background, a whiplash type of injury in most cases. Despite the fact that TOS is made only of symptoms, "diagnosing" it has led to scores of operations, scalenotomy in the past, now mostly resection of the first rib, sometimes scalenectomy. Huge surgical statistics, that deal mostly with resection of the first rib, have not proven the authenticity of this second variety of the 5th syndrome. Surgeons report only early surgical results, and the results claimed are invariably impressive. Never is there a statistic about return to work after surgery. First rib resection can be dangerous and it can be complicated by tardy permanent brachial plexopathy. One very recent European study proves the discrepancy between the early appreciation of the results by the surgeon and the late appreciation by independent observers.
胸廓出口综合征有5种类型。前4种，尽管不太为人所知，尤其是前两种，但却是真实存在的；它们分别是：1）动脉型，由发育良好的颈肋或发育不完全的第一肋引起；2）神经型，与与未发育完全的颈肋或C7粗大横突相关的纤维带有关；3）静脉型，即“用力性血栓形成”；4）创伤后晚期型，继发于锁骨骨折。对这4种综合征的研究为读者了解有争议的第5种综合征做了铺垫，第5种综合征完全是主观的，仅由症状构成。第5种综合征在文献中最为常见，过去称为“前斜角肌综合征”，现在北美作者称之为“胸廓出口综合征”或“TOS”，有两种类型，一种是低张力肩部肌肉，多见于女性，对特定且简单的锻炼反应良好，另一种是有事故背景，大多数情况下是挥鞭样损伤。尽管TOS仅由症状构成，但对其“诊断”已导致大量手术，过去是斜角肌切断术，现在大多是第一肋切除术，有时是斜角肌切除术。大量主要涉及第一肋切除术的外科手术统计数据并未证实第5种综合征这一类型的真实性。外科医生只报告早期手术结果，且声称的结果总是令人印象深刻。从未有过关于术后重返工作岗位的统计数据。第一肋切除术可能很危险，可能会并发迟发性永久性臂丛神经病变。最近一项欧洲研究证明了外科医生对结果的早期评估与独立观察者的后期评估之间存在差异。
