Atasoy Erdoğan
Department of Surgery, University of Louisville School of Medicine, Kleinert Kutz Hand Care Center, Louisville, KY 40202, USA.
J Hand Surg Am. 2010 Sep;35(9):1528-38. doi: 10.1016/j.jhsa.2010.06.025.
Because hand surgeons frequently see patients with arm and hand pain, numbness, and tingling, it is important for them to recognize the possibility of the presence of thoracic outlet compression syndrome (TOCS). Approximately 40% to 50% of patients with this condition have associated peripheral nerve compression symptoms. Only about 10% of patients with suspected TOCS might show some objective evidence during physical examination and other examination modalities. For this reason, TOCS is one of the most overlooked, misdiagnosed, and underrated conditions. During the past 20 years (1989-2009) our surgical experience with combined-approach surgery for TOCS, involving transaxillary first rib resection followed by immediate transcervical anterior and middle scalenectomy, has been gratifying. During this period, more than 750 patients had this combined procedure. Between the end of 1989 and 2002 (13 years), 532 patients (many of whom were from out of state) had this kind of intervention. At the end of 2002, we surveyed our patients for the outcome of their surgery. Unfortunately, we were able to locate only 358 patients, and only 102 patients returned a mailed questionnaire. About 95 patients reported improvement of their symptoms. Since the beginning of 2003, more than 230 patients have had the same procedure. It is our impression that the outcome of the surgery in this last group of patients is at least as good as (if not better than) the earlier reported outcome in the first group of patients. The combined surgical approach to TOCS with transaxillary first rib resection and transcervical scalenectomy is the most complete procedure for total decompression of the thoracic outlet, with a much better rate of improvement of symptoms and a lower rate of recurrences. The surgical techniques of these two procedures are described.
由于手外科医生经常诊治手臂和手部疼痛、麻木及刺痛的患者，因此他们认识到存在胸廓出口综合征（TOCS）的可能性很重要。患有这种疾病的患者中约40%至50%伴有周围神经受压症状。疑似TOCS的患者中只有约10%在体格检查和其他检查方式中可能显示出一些客观证据。因此，TOCS是最容易被忽视、误诊和低估的疾病之一。在过去20年（1989 - 2009年）中，我们采用联合手术方法治疗TOCS的手术经验令人满意，该联合手术包括经腋路第一肋切除术，随后立即进行经颈前路和中斜角肌切除术。在此期间，超过750名患者接受了这种联合手术。在1989年底至2002年（13年）期间，532名患者（其中许多来自其他州）接受了这种干预。2002年底，我们对患者的手术结果进行了调查。不幸的是，我们仅找到了358名患者，只有102名患者回复了邮寄的问卷。约95名患者报告症状有所改善。自2003年初以来，已有超过230名患者接受了相同的手术。我们的印象是，最后一组患者的手术结果至少与第一组患者早期报告的结果一样好（如果不是更好的话）。采用经腋路第一肋切除术和经颈斜角肌切除术的联合手术方法治疗TOCS是胸廓出口完全减压的最完整手术，症状改善率更高，复发率更低。本文描述了这两种手术的技术。
