Sessions R T
South Med J. 1982 Dec;75(12):1453-61. doi: 10.1097/00007611-198212000-00004.
The clinical history and operative findings in a group of 29 patients who underwent reoperation for thoracic outlet syndrome (TOS) are presented. Recurrence of TOS following initial surgical treatment was found to be operation-related (retained first rib segments, regrowth of periosteum), postoperation-related (infection, too early mobilization), or trauma-related. Recurrent TOS may be classified by the location of brachial plexus fixation. In recurrent lower tract TOS the plexus is fixed to the chest wall at the level of the first rib; in recurrent upper tract TOS the plexus is fixed in the neck by the reattached anterior scalene muscle. Surgical treatment of recurrent lower tract TOS involves neurolysis, removal of retained first rib segments or regenerated periosteum, and interposition of a fat-pad pedicle graft between the plexus and the chest wall. Treatment of recurrent upper tract TOS involves scalenectomy, neurolysis, and coverage of the plexus by healthy fat.
本文介绍了一组29例因胸廓出口综合征（TOS）接受再次手术患者的临床病史和手术结果。初次手术治疗后TOS复发与手术相关（保留第一肋骨节段、骨膜再生）、术后相关（感染、过早活动）或创伤相关。复发性TOS可根据臂丛神经固定的位置进行分类。在复发性下干型TOS中，臂丛神经在第一肋骨水平固定于胸壁；在复发性上干型TOS中，臂丛神经通过重新附着的前斜角肌固定于颈部。复发性下干型TOS的手术治疗包括神经松解、切除保留的第一肋骨节段或再生的骨膜，以及在臂丛神经和胸壁之间置入带蒂脂肪垫移植物。复发性上干型TOS的治疗包括斜角肌切除术、神经松解，并用健康脂肪覆盖臂丛神经。
