Curuk C, Ohida H, Gebauer T, Stegemann E, Buerger T
Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119, Kassel, Germany.
Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119, Kassel, Germany.
Int J Surg Case Rep. 2020;75:521-525. doi: 10.1016/j.ijscr.2020.09.134. Epub 2020 Sep 23.
Thoracic outlet Syndrome (TOS) includes all disorders caused by compression of all neurovascular Structures in the upper thoracic outlet (Ross and Owners, 1966, Bürger and Arterien, 2014, Sanders and Annest, 2017). The Double-Crush-Syndrome (DBS) defines multilevel lesions along a neurovascular trunk caused by mechanical compression in different areas. Pectoralis-minor-syndrome (PMS) is also classified in the disorders of he upper thoracic outlet and was also known as hyperabductionsyndrome or subcoracoidal-syndrome. Between 2015-2019 our department treatet 488 patients suffering from neurological, vascular or combined TOS. Surgical treatment, depending on clinical and specific diagnostics was performed in 175 cases via transaxillary approach, including cervical rib resection, first rib resection, neurolysis of plexus brachialis, thoracal sympathectomy or vascular reconstruction. In all this year just a single patient with double crush syndrome was present. CASE PRESENTATION AND METHODS: We report a case of a 28-years old female patient, reported in line with the SCARE criteria [13], suffering from neurvascular compression in the upper thoracic outlet after surgically treated clavicula fracture. She developed typical symptomes of a Thoracic Outlet Syndrome. CONCLUSION: Double-Crush-Syndrome in patients with Thoracic Outlet Syndrome are very rare, case reports seldomly exist. The diagnosis requires a specific clinical testing and x-ray radiography. Furthermore dynamic tests like ultrasound and angiography and neurophysiological testing requires a high degree of experience, so the compressed area can be detected. Treatment includes an attempt of best medical and physical therapy, in case of failure a surgical treatment is necessary.
胸廓出口综合征（TOS）包括所有由上胸廓出口处神经血管结构受压引起的病症（罗斯和奥纳尔斯，1966年；比尔格和阿特里恩，2014年；桑德斯和安妮斯特，2017年）。双压迫综合征（DBS）定义为由不同区域的机械压迫导致的沿神经血管干的多节段病变。胸小肌综合征（PMS）也归类于上胸廓出口病症，也被称为过度外展综合征或喙突下综合征。2015年至2019年期间，我们科室治疗了488例患有神经型、血管型或混合型TOS的患者。根据临床和具体诊断，175例患者通过经腋窝入路进行了手术治疗，包括颈肋切除术、第一肋切除术、臂丛神经松解术、胸交感神经切除术或血管重建术。在这几年中仅出现了1例双压迫综合征患者。病例报告与方法：我们报告1例28岁女性患者，符合SCARE标准[13]，在锁骨骨折手术治疗后出现上胸廓出口处神经血管受压。她出现了胸廓出口综合征的典型症状。结论：胸廓出口综合征患者中的双压迫综合征非常罕见，病例报告很少见。诊断需要特定的临床检查和X线摄影。此外，像超声、血管造影和神经生理学检查等动态检查需要高度的经验，以便能够检测出受压区域。治疗包括尝试最佳的药物和物理治疗，若治疗失败则需要手术治疗。
