Martinez Del Carmen Dorelly Tanayra, Martí Mestre Francisco Xavier, Tripodi Paolo, Macia Vidueira Ivan, Ramos Izquierdo Ricard, Romera Villegas Antonio
Angiology and Vascular Surgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Angiology and Vascular Surgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Ann Vasc Surg. 2022 Apr;81:225-231. doi: 10.1016/j.avsg.2021.09.032. Epub 2021 Nov 11.
Thoracic outlet syndrome (TOS) causes neurogenic symptoms in 95% of the cases due to neurovascular bundle compression. The treatment goal is the decompression of the neurovascular structures. In the last decade, non-surgical treatments have been evaluated as a treatment option for spastic syndromes and thoracic outlet syndrome. In this study we report the use of botulinum toxin (BTX-A) injection as a diagnostic tool to identify the pectoral minor syndrome, and as a less aggressive treatment-option.
An observational cohort study of patients with neurogenic thoracic outlet syndrome who underwent sonographically guided chemodenervation of pectoral minor muscle with botulinum toxin. Follow-up includes clinical evaluation at one month, 3 months and 6 months after the procedure. Clinical evaluation was made with clinical questionnaire. In case of patients with partial improvement of the symptoms, a second infiltration of BTX-A was performed. The categorical variables were shown as percentages, and the continuous variables as mean and standard deviation (SD). For the comparison of categorical variables, the Fisher's exact test was used. Statistical analysis was performed using the SPSS version 20.0 program. We consider P <0.05 to be statistically significant.
A total of twenty-six patients were diagnosed with thoracic outlet syndrome in this period, and 20 accomplished the inclusion criteria. 7 patients were excluded (1 due to neoplasia, 2 did not sign the informed consent, 1 due to neoplasia, 2 did not sign the informed consent, 1 was lost during the follow-up and 3 due to anomalies of the first rib secondary to fractures and cervical rib and 1 was lost during the follow-up), therefore a sample of 13 patients aged between 24 and 55 years was obtained. The most common type of procedure performed was the single injection of 50 IU of botulinum toxin. 4 patients were infiltrated in 2 occasions due to partial improvement in symptoms at 1month follow-up. Clinical stability was found at three months and at 6 months follow-up.
The ultrasound-guided botulinum injection of the pectoralis minor muscles provides symptoms relief in patients with pectoral minor syndrome, and could be considered a safe tool in the diagnosis of the pectoralis minor syndrome within the spectrum of thoracic operculum syndrome.
胸廓出口综合征（TOS）在95%的病例中因神经血管束受压而导致神经源性症状。治疗目标是解除神经血管结构的压迫。在过去十年中，非手术治疗已被评估为痉挛综合征和胸廓出口综合征的一种治疗选择。在本研究中，我们报告了使用肉毒杆菌毒素（BTX-A）注射作为一种诊断工具来识别胸小肌综合征，并作为一种侵入性较小的治疗选择。
对接受超声引导下肉毒杆菌毒素化学去神经支配治疗的神经源性胸廓出口综合征患者进行观察性队列研究。随访包括术后1个月、3个月和6个月的临床评估。通过临床问卷进行临床评估。对于症状部分改善的患者，进行第二次BTX-A注射。分类变量以百分比表示，连续变量以均值和标准差（SD）表示。对于分类变量的比较，使用Fisher精确检验。使用SPSS 20.0程序进行统计分析。我们认为P<0.05具有统计学意义。
在此期间，共有26例患者被诊断为胸廓出口综合征，20例符合纳入标准。7例患者被排除（1例因肿瘤，2例未签署知情同意书，1例因肿瘤，2例未签署知情同意书，1例在随访期间失访以及3例因第一肋骨继发于骨折、颈肋的异常，1例在随访期间失访），因此获得了13例年龄在24至55岁之间的患者样本。最常见的操作类型是单次注射50 IU肉毒杆菌毒素。4例患者因1个月随访时症状部分改善而接受了2次注射。在3个月和6个月随访时发现临床症状稳定。
超声引导下对胸小肌进行肉毒杆菌毒素注射可缓解胸小肌综合征患者的症状，并且在胸廓出口综合征范围内可被视为诊断胸小肌综合征的一种安全工具。
