Hawkes C D
Clin Orthop Relat Res. 1986 Jun(207):24-8.
The neurosurgeon is often consulted in cases of shoulder-arm pain that have as their cause compression of the neurovascular bundle in the thoracic outlet. He or she should, therefore, be familiar with the clinical presentation and differential diagnosis of this syndrome, as well as the electrographic and angiographic findings that may be present in this condition. If the diagnosis is established and the patient proves refractory to conservative treatment with physical therapy, medication, exercises, and modification of activities, the neurosurgeon may elect to perform scalenotomy, paying particular attention to the fibrous bands and anomalies in the scalene group of muscles that may play a major role in the compression of the brachial plexus and brachial vessels. Resection of a cervical rib or anomalous first rib may also prove necessary. Primary arterial and venous problems, which occur in approximately ten percent of these cases, are best left to the thoracic surgeon, but the transthoracic approach plus sympathectomy, if indicated, may be carried out by the neurosurgeon if he has been trained in this procedure. Emotional problems are often present in patients with this syndrome, but careful selection of surgical candidates will lead to a favorable outcome in 80% or better of such cases.
对于因胸廓出口处神经血管束受压而导致肩臂疼痛的病例，神经外科医生常被咨询。因此，他或她应该熟悉这种综合征的临床表现和鉴别诊断，以及这种情况下可能出现的电生理和血管造影结果。如果确诊，且患者经物理治疗、药物治疗、锻炼以及活动调整等保守治疗无效，神经外科医生可能会选择进行斜角肌切断术，尤其要注意斜角肌群中可能在臂丛神经和臂血管受压中起主要作用的纤维带和异常情况。切除颈肋或异常的第一肋可能也很有必要。在这些病例中约10%会出现原发性动脉和静脉问题，最好由胸外科医生处理，但如果有指征，经胸入路加交感神经切除术若神经外科医生接受过该手术的培训也可由其实施。患有这种综合征的患者常常存在情绪问题，但仔细挑选手术候选人将使80%或更多此类病例获得良好的治疗效果。
