Department of Neurosurgery, CHU Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium.
Acta Neurochir (Wien). 2012 Mar;154(3):517-26. doi: 10.1007/s00701-011-1269-x. Epub 2012 Jan 24.
To evaluate the clinical presentation, diagnostic and therapeutic management and outcome of 27 cases of post-traumatic thoracic outlet syndrome (PT TOS).
Retrospective chart analysis.
Nineteen women and eight men were included in this study. Involvement in a traffic accident was the most common scenario. Fracture of either the first rib or the clavicle was reported in eight patients at the time of injury; in others, the diagnosis was cervical or shoulder soft tissue trauma. Upon presentation at our clinic at a mean 41 months after injury, four patients had bilateral symptoms and 17 reported decreased function of either the arm or hand. Two patients presented with severe lower trunk deficits including one who had received surgical intervention at both the cervical spine and elbow before diagnosis of TOS was made. Sixteen and 15 patients were suffering from some degree of anxiety and/or depression. Upon diagnosis of neurogenic TOS, the two patients with atrophy of the hand musculature were treated surgically. Conservative treatment was applied to all other patients. Six months after presentation to our clinic, nine patients demonstrated a significant improvement. The remainder that reported incapacitating symptoms were offered surgical treatment. Three patients declined the latter. Fifteen patients received surgical treatment via an anterior supraclavicular approach with resection of the anterior scalene muscles. Eleven patients had resection of the middle scalene muscle while five had resection of an osseous structure (partial claviculectomy, C7 transverse process or a cervical rib). The two patients with atrophy of the hand only slightly improved their motor deficit but had a notable relief of symptoms of pain. Postoperative improvement occurred in 80% of surgically treated patients.
The majority of patients suffering from a post-traumatic TOS present a neurogenic, usually subjective syndrome. Prompt therapeutic management is necessary, addressing both physical and psychological complaints. Most patients are cured or well improved by conservative and/or surgical treatment.
评估 27 例创伤后胸廓出口综合征（PT TOS）的临床症状、诊断、治疗管理和结局。
回顾性图表分析。
本研究纳入 19 名女性和 8 名男性。最常见的损伤场景是交通事故。8 名患者在受伤时报告第一肋骨或锁骨骨折；在其他患者中，诊断为颈椎或肩部软组织损伤。在受伤后平均 41 个月就诊于我院时，4 名患者有双侧症状，17 名患者出现手臂或手部功能减退。2 名患者出现严重的下躯干功能障碍，其中 1 名在诊断 TOS 之前已在颈椎和肘部接受了手术干预。16 名和 15 名患者存在不同程度的焦虑和/或抑郁。诊断为神经源性 TOS 后，手部肌肉萎缩的 2 名患者接受了手术治疗。所有其他患者均接受了保守治疗。就诊后 6 个月，9 名患者症状显著改善。其余报告有严重症状的患者接受了手术治疗。3 名患者拒绝手术。15 名患者通过锁骨上前路入路接受手术治疗，切除前斜角肌。11 名患者切除中斜角肌，5 名患者切除骨结构（部分锁骨切除术、C7 横突或颈椎肋）。仅手部肌肉萎缩的 2 名患者运动功能障碍略有改善，但疼痛症状明显缓解。手术治疗的患者中有 80%术后得到改善。
大多数创伤后 TOS 患者表现为神经源性、通常为主观性综合征。需要及时进行治疗管理，解决身体和心理两方面的问题。大多数患者通过保守和/或手术治疗得到治愈或显著改善。
