De Silva Gayan, Ohman J Westley, Henderson Karen M, Goestenkors Danita M, Meyer Richard D, Thompson Robert W
The Center for Thoracic Outlet Syndrome and Department of Surgery, Section of Vascular Surgery, Washington University in St. Louis School of Medicine, MO, USA.
Department of Vascular Surgery, Cleveland Clinic, Avon-Richard E. Jacobs Health Center, OH, USA.
Hand (N Y). 2024 Oct 18:15589447241286240. doi: 10.1177/15589447241286240.
Uncertainty exists concerning the optimal utilization and effectiveness of pectoralis minor tenotomy (PMT) in neurogenic thoracic outlet syndrome (NTOS).
Between January 2020 and July 2023, 355 patients with NTOS underwent primary surgical treatment. Prospectively collected data were analyzed retrospectively.
Overall mean patient age was 35.9 ± 1.9 years, 76% were female, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at presentation was 60.3 ± 3.2, reflecting substantial disability. Surgical treatment was based on localized tenderness/symptoms to palpation, with 322 (91%) undergoing combined supraclavicular decompression and PMT (SCD + PMT) and 33 (9%) selected for isolated PMT when findings were solely confined to the subcoracoid space. Mean operative time (29 ± 5 vs 164 ± 9 min, < .01) and hospital stay (0.3 ± 0.1 vs 4.0 ± 0.2 days, < .01) were both lower after isolated PMT, with no significant differences in postoperative complications or rehospitalization. During follow-up of 26.7 ± 1.5 months, QuickDASH scores declined by 41.2% ± 2.3% ( < .0001) and patient-rated outcomes were excellent in 34%, good in 41%, fair in 22%, and poor in 4%. Fewer patients had poor-rated outcomes after SCD + PMT (2%) than after isolated PMT (19%) ( < .01). Recurrent symptoms requiring supraclavicular reoperation occurred in 16 patients after SCD + PMT (5%) and in 5 patients after isolated PMT (15%) ( < .05).
Pectoralis minor tenotomy (PMT) has an important role in surgical treatment of NTOS, mainly as an adjunct in combination with SCD. While highly selected patients can do well after isolated PMT as a short outpatient procedure with rapid recovery, there is a greater potential for poor outcomes and supraclavicular reoperation than after SCD + PMT.
关于胸小肌切断术（PMT）在神经源性胸廓出口综合征（NTOS）中的最佳应用及有效性存在不确定性。
在2020年1月至2023年7月期间，355例NTOS患者接受了初次手术治疗。对前瞻性收集的数据进行回顾性分析。
患者总体平均年龄为35.9±1.9岁，76%为女性，就诊时上肢、肩部和手部快速残疾量表（QuickDASH）评分为60.3±3.2，表明残疾程度严重。手术治疗基于触诊时的局部压痛/症状，322例（91%）接受了锁骨上减压联合胸小肌切断术（SCD+PMT），33例（9%）在检查结果仅局限于喙突下间隙时选择了单纯胸小肌切断术。单纯胸小肌切断术后平均手术时间（29±5分钟对164±9分钟，P<0.01）和住院时间（0.3±0.1天对4.0±0.2天，P<0.01）均较短，术后并发症或再次住院方面无显著差异。在26.7±1.5个月的随访期间，QuickDASH评分下降了41.2%±2.3%（P<0.0001），患者自评结果为优的占34%，良的占41%，中平的占22%，差的占4%。SCD+PMT术后自评结果差的患者（2%）少于单纯胸小肌切断术（19%）（P<0.01）。SCD+PMT术后16例（5%）出现需要再次进行锁骨上手术的复发症状，单纯胸小肌切断术后5例（15%）出现复发症状（P<0.05）。
胸小肌切断术（PMT）在NTOS的手术治疗中具有重要作用，主要作为与SCD联合的辅助手段。虽然经过严格挑选的患者在接受单纯胸小肌切断术作为短期门诊手术且恢复迅速后效果良好，但与SCD+PMT相比，预后不良和再次进行锁骨上手术的可能性更大。
