Diner C, Mathieu L, Vandendries C, Oberlin C, Belkheyar Z
Department of Trauma, Orthopedic and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France.
Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003 Lyon, France; Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005 Paris, France.
Hand Surg Rehabil. 2023 Feb;42(1):9-14. doi: 10.1016/j.hansur.2022.11.009. Epub 2022 Nov 26.
We aimed to evaluate functional outcome following elective brachial plexus decompression by compressive fibrous band resection and limited on-demand bone abnormality resection in patients with neurogenic thoracic outlet syndrome (N-TOS). A retrospective continuous observational study was conducted in 17 patients (15 women and 2 men), with a mean age of 42 years, operated on between 2013 and 2021. Twenty brachial plexus decompressions were performed, for 13 objective and 7 subjective N-TOSs, including 3 recurrent N-TOSs. At last follow-up, outcomes were evaluated in terms of residual pain, paresthesia and hand motor deficit, plus patient-reported assessment and Quick-DASH functional scoring. No postoperative complications occurred. At a median follow-up of 12 months (range 6-48 months), complete pain relief and paresthesia resolution were found in 11/15 and 9/14 cases, respectively. All patients reported that their symptoms had improved. In contrast, hand muscle atrophy persisted in all cases (n = 11). Sensorimotor recovery seemed to be poorer and mean Quick-DASH score better in objective than subjective N-TOS patients. Elective brachial plexus decompression seemed to be a safe procedure, providing constant improvement in subjective symptoms related to lower trunk irritation. However, nerve release did not provide hand muscle recovery in patients with objective N-TOS. LEVEL OF EVIDENCE: IV.
我们旨在评估在患有神经源性胸廓出口综合征（N-TOS）的患者中，通过切除压迫性纤维带和按需进行有限的骨异常切除来进行选择性臂丛神经减压后的功能结果。对2013年至2021年间接受手术的17例患者（15名女性和2名男性）进行了一项回顾性连续观察研究，平均年龄为42岁。共进行了20次臂丛神经减压手术，其中13例为客观性N-TOS，7例为主观性N-TOS，包括3例复发性N-TOS。在最后一次随访时，根据残留疼痛、感觉异常和手部运动功能障碍，以及患者报告的评估和Quick-DASH功能评分对结果进行了评估。未发生术后并发症。在中位随访12个月（范围6 - 48个月）时，分别在11/15例和9/14例患者中发现疼痛完全缓解和感觉异常消失。所有患者均报告其症状有所改善。相比之下，所有病例（n = 11）的手部肌肉萎缩均持续存在。客观性N-TOS患者的感觉运动恢复似乎较差，平均Quick-DASH评分优于主观性N-TOS患者。选择性臂丛神经减压似乎是一种安全的手术方法，可使与下干刺激相关的主观症状持续改善。然而，对于客观性N-TOS患者，神经松解并不能使手部肌肉恢复。证据级别：IV。
