Division of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
J Vasc Surg. 2013 Mar;57(3):771-5. doi: 10.1016/j.jvs.2012.08.110.
The purpose of this study was to review our operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical ribs causing clinical symptoms.
This study is a retrospective review of a prospectively acquired database of patients with TOS treated with first rib resection and scalenectomy with or without cervical rib resection at the Johns Hopkins Medical Institutions.
Between October 2003 and June 2011, a total of 23 cervical rib resections were performed on 20 patients, three of whom had bilateral cervical ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical rib resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical ribs with bony fusion to the first rib were found in 17 of 23 cases (74%).
Cervical ribs causing clinical symptoms are large and frequently fused to the first rib, and can result in aneurysm formation or thrombosis. In our experience, both the cervical rib and the first rib must be removed to relieve arterial compression and can usually be done through a transaxillary approach. Only patients with aneurysms needing arterial reconstruction require resection of the artery from a supraclavicular approach.
本研究旨在回顾我们治疗因颈肋引起临床症状的胸廓出口综合征（TOS）患者的手术经验。
本研究是对约翰霍普金斯医疗中心接受第一肋骨切除术和前斜角肌切除术，或同时行颈肋切除术治疗 TOS 的患者前瞻性采集数据库进行的回顾性研究。
2003 年 10 月至 2011 年 6 月，共对 20 例患者的 23 个颈肋进行了切除，其中 3 例在不同手术中双侧颈肋均被切除。7 例患者出现锁骨下动脉血栓形成。7 例患者中有 3 例出现锁骨下动脉动脉瘤，通过锁骨上入路切除颈肋以利于锁骨下动脉旁路手术。5 例患者表现为无血栓形成的缺血性上肢，行腋前线第一肋骨和颈肋切除术。3 例患者出现锁骨下静脉血栓形成，其中 2 例在术后 2 周行球囊扩张治疗狭窄。此外，5 例患者表现为神经源性 TOS，上肢出现疼痛、麻木和无力，但无血管损伤。23 例中发现 17 例（74%）颈肋与第一肋骨有骨性融合。
引起临床症状的颈肋较大，且常与第一肋骨融合，可导致动脉瘤形成或血栓形成。根据我们的经验，必须切除颈肋和第一肋骨以缓解动脉压迫，通常可通过腋前线入路完成。只有需要动脉重建的动脉瘤患者才需要通过锁骨上入路切除动脉。
