Braun Richard M, Rechnic Mark, Shah Kalpit N
Department of Orthopaedic Surgery, University of California, San Diego, California 92103, USA.
J Hand Surg Am. 2012 Dec;37(12):2564-9. doi: 10.1016/j.jhsa.2012.09.020.
We present our experience in using pulse oximetry as an aid in the diagnosis of thoracic outlet syndrome (TOS). Our attention was given to those symptomatic patients without objective confirmatory data on imaging or electrodiagnostic evaluation.
Using a pulse oximeter, we measured the oxygen saturation and the pulse rate during a provocative extremity abduction stress test exercise maneuver in 18 patients with symptoms and signs consistent with a diagnosis of nonspecific neurogenic TOS. The oxygen saturation and pulse rates in 18 asymptomatic subjects were used as a control.
Resting oxygen saturation above 97% was present in both groups initially. After the provocative exercise maneuver, there was a significant reduction in the oxygen saturation levels, which dropped to 86% in the symptomatic TOS group compared with 94% in the control group. There was a significant increase in pulse rate in those subjects suspected of having TOS compared with a minimal increase in pulse rate in control subjects.
Pulse oximetry produced objective confirmatory measurements, which support a hypothesis that hypoperfusion in the upper limb during provocative activities or exercise may cause disabling symptoms associated with nonspecific neurogenic TOS. This method may be a useful, noninvasive, rapid, and inexpensive clinical tool in the diagnosis of TOS, a condition frequently lacking in objective, confirmatory diagnostic data.
我们介绍了使用脉搏血氧饱和度测定法辅助诊断胸廓出口综合征（TOS）的经验。我们关注的是那些有症状但在影像学或电诊断评估中缺乏客观确诊数据的患者。
我们使用脉搏血氧仪，在18例有症状和体征、符合非特异性神经源性TOS诊断的患者进行激发性上肢外展应激试验操作期间，测量其血氧饱和度和脉搏率。18名无症状受试者的血氧饱和度和脉搏率用作对照。
两组最初静息血氧饱和度均高于97%。激发性运动操作后，血氧饱和度水平显著降低，有症状的TOS组降至86%，而对照组为94%。与对照组脉搏率轻微增加相比，疑似患有TOS的受试者脉搏率显著增加。
脉搏血氧饱和度测定法产生了客观的确诊测量结果，支持了这样一种假设，即激发性活动或运动期间上肢灌注不足可能导致与非特异性神经源性TOS相关的致残症状。这种方法可能是诊断TOS的一种有用、无创、快速且廉价的临床工具，TOS这种疾病常常缺乏客观的确诊诊断数据。
