Pollack E W
Surg Gynecol Obstet. 1980 Jan;150(1):97-103.
Operative and cadaver dissections have shown that neurovascular compression in the thoracocervicoaxillary region occurs most frequently at the following three levels: the superior thoracic outlet, the costoscalenic hiatus and the costoclavicular passage. At each, a fibromuscular and osseous frame surrounds and fits the neurovascular bundle rather snugly. Pathologic conditions and some normal anatomic variants of the frame or of its contents could lead to contents-container space incompatibility, thus producing symptoms of neurovascular compression. Evaluation of the rigid frame of the region has shown that the first thoracic rib is its key element at all three possible levels of compression. Review of the many possible anatomic variants of osseous, fibromuscular and neurovascular components of the passage illustrates the necessary complexity of any operative attempt intended to detect and treat all possible anatomic causes of compression. Removal of the first thoracic rib, regardless of most other anatomic causes for thoracic outlet syndrome, provides a simple alternative by creating a patulous thoroughfare which eliminates all three possible levels of compression, even when other undetected predisposing anatomic structures are not removed.
手术解剖和尸体解剖表明，胸颈腋区域的神经血管受压最常发生在以下三个水平：胸上出口、肋斜角肌裂孔和肋锁通道。在每个部位，一个纤维肌肉和骨性框架紧密地围绕并适配神经血管束。框架或其内容物的病理状况以及一些正常的解剖变异可能导致内容物与容器空间不相容，从而产生神经血管受压症状。对该区域刚性框架的评估表明，第一肋是所有三个可能受压水平的关键要素。对通道的骨性、纤维肌肉和神经血管成分的许多可能解剖变异的回顾说明了任何旨在检测和治疗所有可能解剖性受压原因的手术尝试的必要复杂性。无论胸廓出口综合征的大多数其他解剖原因如何，切除第一肋通过创建一个通畅的通道提供了一种简单的替代方法，该通道消除了所有三个可能的受压水平，即使其他未检测到的易感解剖结构未被切除。
