Department of Neurosurgery, Charité-Universitätsmedizin Berlin; District Hospital of Günzburg, Neurosurgical Department of the University of Ulm; Department of Neurosurgery and Neurorestauration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria; Peripheral Nerve Unit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück; Department of Neurosurgery, Helios Klinikum Erfurt.
Dtsch Arztebl Int. 2022 Oct 28;119(43):735-742. doi: 10.3238/arztebl.m2022.0296.
Thoracic outlet syndrome (TOS) refers to a group of disorders in which there is compression of and/or damage to the neurovascular structures at the thoracic outlet, i.e., at the transition from chest to neck. The incidence of neurogenic thoracic outlet syndrome (nTOS) is estimated to be 2-3 / 100 000 / year, with an estimated prevalence of 10 / 100 000. Patients present with upper extremity sensorimotor symptoms that are often related to movement. The aim of the present article is to highlight the clinical presentation patterns of nTOS and to provide an overview of its diagnosis and treatment.
Selective literature search for prospective observational studies and RCTs, including systematic reviews and metaanalyses.
There is no multicenter randomized controlled trial available on the treatment of nTOS. Prospective observational studies with a hierarchical study design report a positive effect of physiotherapy in 27-59% of cases. After unsuccessful conservative treatment, up to 56-90% benefit from surgical management. Patients with nTOS are more severely affected compared with those with other forms of TOS and benefit less from transaxillary first rib resection. nTOS patients who underwent supraclavicular decompression without rib resection had excellent surgical outcomes in 27%, good outcomes in 36%, acceptable outcomes in 26%, and poor surgical outcomes in 11% of cases. There is no systematic comparison available of the types of surgical management involved. Also, there is currently no uniform classification available for all medical sub-disciplines. Therefore, interpretation, and comparability of the study results are limited.
Although nTOS is the most common form of TOS, studies on its treatment are currently limited in terms of numbers and quality. The type of surgical management varies according to the experience and preference of the surgeon, treating specialty, special anatomic features, and clinical symptoms.
胸廓出口综合征（TOS）是一组由于胸廓出口处（即从胸部到颈部的过渡区域）的神经血管结构受到压迫和/或损伤而引起的疾病。神经源性胸廓出口综合征（nTOS）的发病率估计为每 10 万人中有 2-3 例，患病率估计为每 10 万人中有 10 例。患者表现为上肢感觉运动症状，常与运动有关。本文旨在强调 nTOS 的临床表现模式，并对其诊断和治疗进行概述。
对前瞻性观察性研究和 RCT 进行选择性文献检索，包括系统评价和荟萃分析。
目前尚无关于 nTOS 治疗的多中心随机对照试验。具有层次研究设计的前瞻性观察性研究报告称，物理治疗在 27-59%的病例中有效。在保守治疗失败后，高达 56-90%的患者受益于手术治疗。与其他类型的 TOS 相比，nTOS 患者的病情更为严重，从经腋第一肋骨切除术获益较少。未行肋骨切除术的锁骨上减压术治疗 nTOS 患者，27%的患者手术效果极好，36%的患者效果良好，26%的患者效果可接受，11%的患者手术效果较差。目前尚无关于所涉及的手术治疗类型的系统比较。此外，目前所有医学分科都没有统一的分类。因此，研究结果的解释和可比性受到限制。
尽管 nTOS 是 TOS 最常见的形式，但目前关于其治疗的研究在数量和质量上都受到限制。手术治疗的类型因外科医生的经验和偏好、治疗专业、特殊解剖特征和临床症状而异。
