Unité de chirurgie de la main et du membre supérieur, services d'orthopédie 1 et 2, CHRU de Tours, 37044 Tours, France.
Service de neurophysiologie clinique, Unité d'étude de la conduction nerveuse, CHRU Tours, 37044 Tours, France.
Orthop Traumatol Surg Res. 2022 Sep;108(5):103329. doi: 10.1016/j.otsr.2022.103329. Epub 2022 May 18.
Neurogenic thoracic outlet syndromes (TOS) are dominated by the nonspecific forms. This study focuses only on the rarer true forms related to proximal nerve compression in the thoracic outlet, with the presence of motor (atrophy of the hand's intrinsic muscles) and/or sensory (hypoesthesia in the territory of the medial antebrachial cutaneous nerve) deficits. The objectives of this study were to define the clinical characteristics, anatomical causes and surgical results of this condition.
Single-center retrospective study of 53 consecutive cases in 50 patients with an objective clinical deficit confirmed by nerve conduction studies. The population consisted of 47 adults and 3 children, 9 males and 41 females, with a mean age of 39 years (9-80 years), diagnosed between July 1994 and December 2019. An objective motor deficit was present in 50 cases, with the remaining 3 having a sensory deficit only. Forty cases underwent surgery, most often via the supraclavicular approach, while 13 cases did not undergo surgery because their deficit was longstanding and non-progressive.
One operated patient was lost in follow-up. An analysis of the medical records of 18 cases, including 15 operated cases found complete recovery in 4 cases, significant improvement in 9 cases and small improvement in 2 cases at a mean follow-up of 53 months (1-162 months). Thirty-four cases were reviewed in person, including 24 operated cases and evaluated with a mean follow-up of 135 months (36-284 months): the pain had disappeared in 21 cases, thenar atrophy persisted in 17 cases, which was associated with a claw-hand deformity in 3 cases, while 2 cases had an isolated claw-hand deformity. The patients were very satisfied with the procedure in 15 cases and satisfied in 9 cases. They evaluated the benefit of surgery at 87% and their upper limb function increased from 38% (10-60%) preoperatively to 77% (60-100%) at the review.
Few studies in the literature have focused on true neurogenic TOS cases. The treatment is surgical in progressive cases; an anatomical anomaly is always present. Surgical treatment eliminates the pain and helps to stabilize or even partially resolve the deficit. Despite a moderate objective gain, the patients' feeling of functional improvement is important with a high satisfaction rate.
IV, retrospective.
神经源性胸廓出口综合征（TOS）主要为非特异性形式。本研究仅关注更罕见的与胸廓出口近端神经受压相关的真性形式，存在运动（手部内在肌肉萎缩）和/或感觉（前臂内侧皮神经支配区域感觉减退）缺损。本研究的目的是定义这种情况的临床特征、解剖原因和手术结果。
对 50 例患者的 53 例连续病例进行单中心回顾性研究，这些患者的客观临床缺陷通过神经传导研究得到证实。该人群包括 47 名成人和 3 名儿童，9 名男性和 41 名女性，平均年龄 39 岁（9-80 岁），诊断时间为 1994 年 7 月至 2019 年 12 月。50 例患者存在客观运动缺陷，其余 3 例仅存在感觉缺陷。40 例患者接受了手术，大多数采用锁骨上入路，而 13 例患者因缺陷长期且无进展而未接受手术。
1 例手术患者失访。对 18 例病历（包括 15 例手术病例）进行分析，其中 4 例完全恢复，9 例显著改善，2 例略有改善，平均随访 53 个月（1-162 个月）。34 例患者接受了亲自复查，包括 24 例手术病例，平均随访 135 个月（36-284 个月）：21 例疼痛消失，17 例大鱼际肌萎缩，其中 3 例伴有爪形手畸形，2 例仅有爪形手畸形。15 例患者对手术非常满意，9 例患者满意。他们对手术的获益评估为 87%，上肢功能从术前的 38%（10-60%）增加到复查时的 77%（60-100%）。
文献中很少有研究关注真正的神经源性 TOS 病例。进展性病例的治疗是手术治疗；总是存在解剖异常。手术治疗可消除疼痛，并有助于稳定甚至部分解决缺陷。尽管客观上有一定的改善，但患者对功能改善的感觉很重要，满意度很高。
IV，回顾性。
