Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Arthroscopy. 2017 Aug;33(8):1449-1457. doi: 10.1016/j.arthro.2017.01.050. Epub 2017 Apr 17.
To describe an all-endoscopic technique for infra- and supraclavicular brachial plexus (BP) neurolysis and to assess its functional outcomes for patients suffering from nonspecific neurogenic thoracic outlet syndrome (NTOS).
Between January 2010 and January 2013, 36 patients presenting an idiopathic nonspecific NTOS benefited from an endoscopic decompression in our institution. The inclusion criteria were a typical clinical NTOS and failure of a 6-month well-conducted nonsurgical treatment. Preoperative findings about other shoulder conditions and complementary procedures were exclusion criteria. Interscalene, costoclavicular, and retropectoralis minor spaces were released endoscopically. The primary endpoint was the Disability of the Arm, Shoulder and Hand (DASH) score improvement 6 months after the surgery. Postoperative criteria such as pain relief, paresthesia, upper limb weakness, and provocative tests were also assessed.
Of 36 patients, 10 were excluded and 5 were lost during follow-up. The data of the 21 remaining patients were analyzed after 6 months. Pre- and postoperative mean DASH scores were, respectively, 70 (range 36-98) and 34 (range 2-91). The average improvement was 36 (range -20 to 80), with P = .0002. Pain and paresthesia were relieved in 80% to 90% of the cases. No complication was reported.
Although requiring arthroscopic skills and expert knowledge of the anatomy, our technique seems to be safe and reproducible, and it provides significant functional improvements in the selected patients with nonspecific NTOS, with an average postoperative DASH score improvement of 36%.
Level IV, therapeutic case series.
描述一种用于锁骨下臂丛神经松解的全内镜技术，并评估其对患有非特异性胸廓出口综合征（NTOS）的患者的功能结果。
2010 年 1 月至 2013 年 1 月，我们机构对 36 例特发性非特异性 NTOS 患者进行了内镜减压治疗。纳入标准为典型的临床 NTOS 和 6 个月的非手术治疗失败。其他肩部疾病和补充手术的术前发现为排除标准。通过内镜松解斜角肌、肋锁和小后胸肌间隙。主要终点是术后 6 个月时的手臂、肩部和手残疾（DASH）评分改善。还评估了术后标准，如疼痛缓解、感觉异常、上肢无力和激发试验。
36 例患者中，10 例被排除，5 例在随访期间丢失。21 例患者的随访数据在 6 个月后进行了分析。术前和术后平均 DASH 评分分别为 70（范围 36-98）和 34（范围 2-91）。平均改善为 36（范围-20 至 80），P=.0002。80%至 90%的病例疼痛和感觉异常得到缓解。无并发症报告。
尽管需要关节镜技能和对解剖结构的专业知识，但我们的技术似乎是安全且可重复的，它为非特异性 NTOS 患者提供了显著的功能改善，平均术后 DASH 评分改善 36%。
IV 级，治疗病例系列。
