Jiang David, Weiss Robert, Lind Benjamin, Morcos Omar, Lee Cheong Jun
Section of Vascular Surgery and Endovascular Therapy, University of Chicago Medicine, Chicago, USA.
Division of Vascular Surgery, NorthShore University Health System, Evanston, IL, USA.
Vasc Specialist Int. 2024 Jun 11;40:19. doi: 10.5758/vsi.240011.
This study aims to examine predisposing anatomic factors and subsequent post-decompression functional outcomes among high-intensity athletes with thoracic outlet syndrome (TOS).
A single-institution retrospective review was performed on a prospective database of patients with TOS from 2018 to 2023 who had undergone operative decompression for TOS. Demographics, TOS characteristics, predisposing anatomy, operative details, and postoperative outcomes were examined. The primary outcome was postoperative return to sport. Secondary outcomes included vascular patency.
A total of 13 patients who were engaged in high-demand athletic activity at the time of their diagnosis were included. Diagnoses included 8 (62%) patients with venous TOS, 4 (31%) patients with neurogenic TOS, and 1 (8%) patient with arterial TOS. Mixed vascular and neurogenic TOS was observed in 3 (23%) patients. The mean age of the cohort was 30 years. Abnormal scalene structure was observed in 12 (92%) patients, and abnormal bone structures were noted in 4 (27%) patients; 2 (15%) with cervical ribs and 3 (23%) patients with clavicular abnormalities. Prior ipsilateral upper extremity trauma was reported in 4 (27%) patients. Significant joint hypermobility was observed in 8 (62%) patients with a median Beighton score of 6. Supraclavicular cervical and/or first rib resection with scalenectomy was performed in all patients. One case of postoperative pneumothorax was treated non-operatively. Ten (77%) patients returned to sport. Duplex ultrasonography showed subclavian vein patency in all 8 patients with venous TOS and wide patency with no drop in perfusion indices in the patient with arterial TOS.
Athletes with TOS who required operative intervention had a high incidence of musculoskeletal aberrations and joint hypermobility. Supraclavicular decompression was associated with a high success rate, with overall good functional outcomes and good likelihood of patients returning to preoperative high-intensity athletics.
本研究旨在探讨患有胸廓出口综合征（TOS）的高强度运动员的易感解剖因素及减压术后的功能结局。
对2018年至2023年在单一机构接受TOS手术减压的患者的前瞻性数据库进行回顾性研究。检查了人口统计学、TOS特征、易感解剖结构、手术细节和术后结局。主要结局是术后恢复运动。次要结局包括血管通畅情况。
共纳入13例在诊断时从事高需求体育活动的患者。诊断包括8例（62%）静脉型TOS患者、4例（31%）神经型TOS患者和1例（8%）动脉型TOS患者。3例（23%）患者观察到混合性血管和神经型TOS。该队列的平均年龄为30岁。12例（92%）患者观察到斜角肌结构异常，4例（27%）患者观察到骨骼结构异常；2例（15%）有颈肋，3例（23%）患者有锁骨异常。4例（27%）患者报告有同侧上肢既往创伤史。8例（62%）患者观察到明显的关节过度活动，Beighton评分中位数为6。所有患者均行锁骨上颈段和/或第一肋切除并切除斜角肌。1例术后气胸患者接受了非手术治疗。10例（77%）患者恢复运动。双功超声显示，所有8例静脉型TOS患者的锁骨下静脉通畅，动脉型TOS患者的血管通畅良好，灌注指数无下降。
需要手术干预的TOS运动员肌肉骨骼异常和关节过度活动的发生率较高。锁骨上减压成功率高，功能结局总体良好，患者恢复术前高强度运动的可能性较大。
