Günther T, Gerganov V M, Samii M, Samii A
Gemeinschaftspraxis für Neurochirurgie, Hildesheim, Germany.
Neurol Res. 2010 May;32(4):421-4. doi: 10.1179/174313209X459192. Epub 2009 Aug 5.
Despite the relatively high incidence of the thoracic outlet syndrome, diagnostic criteria, role of surgery and optimal operative approach remain controversial. The main goal of the current study is to determine the long-term outcome of operative treatment of a series of patients with non-specific neurogenic thoracic outlet syndrome.
A retrospective study of a consecutive group of patients with thoracic outlet syndrome was carried out. The indications for surgery relied on clinical examination. Patients with diffuse pain were excluded. In all cases, the supraclavicular approach was used. Main outcome measures were neurological status and subjective complains.
Nineteen patients have been operated over a period of 5 years. Total number of surgeries was 23. Pain and paresthesia on exertion were the leading symptoms in all cases. The causes of thoracic outlet syndrome were fibromuscular compression in 43.5%, cervical rib alone or in combination with a fibromuscular component in 30.4% and the first rib in 26.1%. The average follow-up was 36.3 months. In 91.7%, improvement of at least 50% was observed; 20.8% of the patients were completely symptom-free, and in 25%, the improvement was 90%. Recovery of the pre-operative motor weakness was recorded in 66.6%. The mortality and the permanent morbidity rates of the procedure were 0%.
Operative decompression of the brachial plexus via the supraclavicular approach in patients with non-specific neurogenic thoracic outlet syndrome is a safe procedure that leads to a significant neurological improvement and amelioration of complains. The indication for surgery should be based chiefly on the neurological and clinical findings.
尽管胸廓出口综合征的发病率相对较高，但其诊断标准、手术作用及最佳手术方式仍存在争议。本研究的主要目的是确定一系列非特异性神经源性胸廓出口综合征患者手术治疗的长期疗效。
对一组连续的胸廓出口综合征患者进行回顾性研究。手术指征基于临床检查。排除弥漫性疼痛患者。所有病例均采用锁骨上入路。主要观察指标为神经状态和主观症状。
在5年期间，19例患者接受了手术，手术总数为23例。所有病例中，用力时疼痛和感觉异常是主要症状。胸廓出口综合征的病因中，纤维肌肉压迫占43.5%，单独的颈肋或合并纤维肌肉成分占30.4%，第一肋占26.1%。平均随访36.3个月。91.7%的患者症状改善至少50%；20.8%的患者完全无症状，25%的患者改善达90%。66.6%的患者术前运动无力得到恢复。该手术的死亡率和永久性并发症发生率均为0%。
对于非特异性神经源性胸廓出口综合征患者，通过锁骨上入路对臂丛神经进行手术减压是一种安全的手术方法，可显著改善神经功能并缓解症状。手术指征应主要基于神经学和临床检查结果。
