The University of Alabama at Birmingham, USA.
Brookwood Baptist Health, Birmingham, AL, USA.
Hand (N Y). 2022 Jan;17(1):43-49. doi: 10.1177/1558944719901319. Epub 2020 Feb 10.
Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.
尽管胸廓出口综合征 (TOS) 的诊断常常被忽视，但手术干预的结果显著提高了患者的满意度。本文旨在强调青少年胸廓出口减压术的患者特征、术中发现以及短期和长期结果。对 2000 年至 2015 年间因临床诊断为神经源性胸廓出口综合征 (NTOS) 而接受手术治疗的 13 至 21 岁患者进行了回顾性图表分析。收集了术前患者特征和术中发现等数据点。此外，还获得了一组随访时间为 2 至 15 年的患者的患者报告结果评分，包括视觉模拟量表 (VAS)、单项评估数值评估 (SANE)、快速上肢、肩部和手残疾问卷 (QuickDASH)、颈椎臂症状问卷 (CBSQ) 和 NTOS 指数。研究人群包括 54 例患者共 61 例肢体。最常见的手术包括锁骨上臂丛神经松解术 (60 例，98.4%)、前斜角肌切除术 (59 例，96.7%)和中斜角肌切除术 (54 例，88.5%)。28 例患者行第一肋切除术 (FRR) (45.9%)。对 54 例患者中的 24 例 (44%)进行了长期随访，平均随访时间为 69.5 个月(范围 24-180 个月)。VAS 平均从术前的 7.5 分改善至术后的 1.8 分。SANE 平均从术前的 28.9 分增加至术后的 85.4 分。术后 QuickDASH 评分为 11.4，CBSQ 评分为 27.4，NTOS 指数评分为 17.2。对行 FRR(28 例，45.9%)的患者进行亚组分析，与未行 FRR 的患者相比，其临床疗效评估指标无差异。青少年 NTOS 的手术治疗具有良好的中期和长期结果。
