Ruopsa Niina, Ristolainen Leena, Vastamäki Martti, Vastamäki Heidi
Research Institute Orton and Orton Orthopaedic Hospital, 00280 Helsinki, Finland.
Department of Hand Surgery, Tampere University Hospital, 33521 Tampere, Finland.
Diagnostics (Basel). 2021 Mar 5;11(3):450. doi: 10.3390/diagnostics11030450.
Our aim was to define clinical long-term outcome of surgery for neurogenic thoracic outlet syndrome without rib resection, and to find factors predicting long-term results. For the 94 patients, the main outcomes were pain, numbness, weakness, and upper-extremity function. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey, the Cervical-Brachial Symptom Questionnaire (CBSQ), and a numerical rating system served as functional outcome measures. Mean follow-up was 12.9 years. Preoperative pain diminished from 7.8 to 2.2, numbness from 7.4 to 4.0, and weakness from 7.3 to 3.8. Grip strength increased from 25.7 to 31.8 kg. QuickDASH averaged at follow-up 37.1 and CBSQ 51.5. No correlation appeared between smoking and long-term results regarding pain, numbness, weakness, or functioning. Positive TOS provocative tests or intraoperative anatomical findings like consistency of the scaleni muscles showed no correlation with outcome. 82% of female and 57% of male patients reported that aid from this surgery had been excellent or good; 69% reported that surgery helped considerably for at least a mean 9.9 years. The risk for worse self-reported long-term outcome was higher among men, but neither BMI nor age at surgery associated with self-reported outcome. Pain, numbness, and weakness significantly decreased and function improved after supraclavicular release without rib resection. We found no significant preoperative nor per-operative factors predicting long-term results.
我们的目的是确定不进行肋骨切除的手术治疗神经源性胸廓出口综合征的临床长期疗效，并找出预测长期疗效的因素。对于94例患者，主要疗效指标为疼痛、麻木、无力和上肢功能。上肢、肩部和手部快速残疾评估问卷（QuickDASH）、颈臂症状问卷（CBSQ）以及数字评分系统作为功能疗效指标。平均随访时间为12.9年。术前疼痛评分从7.8降至2.2，麻木评分从7.4降至4.0，无力评分从7.3降至3.8。握力从25.7千克增加到31.8千克。随访时QuickDASH平均评分为37.1，CBSQ平均评分为51.5。吸烟与疼痛、麻木、无力或功能方面的长期疗效之间未发现相关性。阳性胸廓出口综合征激发试验或术中解剖学发现（如斜角肌的情况）与疗效无关。82%的女性患者和57%的男性患者报告该手术的帮助非常好或良好；69%的患者报告手术至少在平均9.9年的时间里有很大帮助。自我报告的长期疗效较差的风险在男性中更高，但体重指数（BMI）和手术时的年龄均与自我报告的疗效无关。在不进行肋骨切除的锁骨上松解术后，疼痛、麻木和无力明显减轻，功能得到改善。我们未发现术前和术中的显著因素可预测长期疗效。
