Rollo Johnathon, Rigberg David, Gelabert Hugh
Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
Ann Vasc Surg. 2017 Jul;42:63.e1-63.e6. doi: 10.1016/j.avsg.2016.10.051. Epub 2017 Mar 8.
Vascular quadrilateral space syndrome (vQSS) is an underdiagnosed cause of extremity ischemia, pain, and paresthesia in overhand throwing athletes. The mechanism of vQSS is thought to result from repeated abduction and external rotation of the arm leading to a distraction injury of the posterior circumflex humoral artery (PCHA) as this courses through the quadrilateral space. This trauma may cause dissection and dissecting aneurysm formation. Thrombus from this arterial injury then embolizes down the arm resulting in the symptomatic presentation. Patients were often presented after multiple embolic events, which have resulted in obliteration of digital arteries. Later stages of presentation may include ischemic ulceration and gangrene. We report 3 cases of vQSS in overhand throwing athletes. All 3 underwent surgical correction and have returned to competition. We discuss presentation, diagnosis, imaging findings, management, outcomes, and review of the literature. Prompt recognition of this syndrome is essential to optimal treatment, which includes PCHA ligation and division with or without thrombolytic therapy. Increased awareness of vQSS is needed among coaches and athletic trainers who often identify the symptoms and initiate the treatment. When treated promptly, these athletes return to baseline functional status.
血管四边形间隙综合征（vQSS）是导致过顶投掷运动员肢体缺血、疼痛和感觉异常的一种常被漏诊的病因。vQSS的发病机制被认为是由于手臂反复外展和外旋，导致旋肱后动脉（PCHA）在穿过四边形间隙时受到牵拉伤。这种创伤可能会导致动脉夹层和夹层动脉瘤形成。动脉损伤形成的血栓随后会顺行栓塞至手臂，从而出现症状。患者常在多次栓塞事件后就诊，这些事件导致指动脉闭塞。疾病后期可能包括缺血性溃疡和坏疽。我们报告3例过顶投掷运动员的vQSS病例。所有3例均接受了手术矫正，现已恢复比赛。我们讨论了其临床表现、诊断、影像学表现、治疗、预后，并对相关文献进行了综述。及时识别该综合征对于最佳治疗至关重要，最佳治疗包括结扎和切断PCHA，可联合或不联合溶栓治疗。教练和运动训练师需要提高对vQSS的认识，他们常能识别症状并启动治疗。如果及时治疗，这些运动员可恢复至基线功能状态。
