Sanders R J, Monsour J W, Gerber W F, Adams W R, Thompson N
Surgery. 1979 Jan;85(1):109-21.
Five years ago a follow-up study of first rib resections disclosed a recurrence rate of over 15%. Many patients were reexplored supraclavicularly, and in every case the anterior scalene muslce was found to be reattached to the bed of the first rib. Scalenectomy invariably was successful, which led to this study of scalenctomy as the first operation for all cases of persistent thoracic outlet syndrome (TOS). The study revealed that most patients with TOS gave a history of neck trauma and had symptoms not only of paraesthesias of the hands and weakness of the arms, but also of neck pains and headaches. The common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. A scalene muslce block with a local anesthetic was the most useful diagnostic test. The good-to-excellent long-term results following 239 scalenctomies and 214 first rib resections were almost identical, 68% and 70%, respectively, with fair results in 20% and 13%, respectively. In patients with a history of neck trauma followed by headache, neck pain, arm weakness, and parasthesias in the hand, anterior and middle scalenectomy should be considered. On the other hand, first rib resection is recommended for patients with no history of neck trauma and symptoms limited to the arm and hand, particularly those patients with signs of arterial or venous insufficiency.
五年前，一项对第一肋切除术的随访研究显示复发率超过15%。许多患者在锁骨上再次接受探查，并且在每例病例中均发现前斜角肌重新附着于第一肋的床面。斜角肌切除术无一例外地取得成功，这促使开展了此项将斜角肌切除术作为所有持续性胸廓出口综合征（TOS）病例的首次手术的研究。该研究表明，大多数TOS患者有颈部创伤史，不仅有手部感觉异常和手臂无力的症状，还有颈部疼痛和头痛的症状。常见的体格检查发现是斜角肌压痛以及手臂上举时症状重复出现。用局部麻醉剂进行斜角肌阻滞是最有用的诊断测试。239例斜角肌切除术和214例第一肋切除术后的长期效果良好至极佳的比例几乎相同，分别为68%和70%，效果一般的比例分别为20%和13%。对于有颈部创伤史，随后出现头痛、颈部疼痛、手臂无力和手部感觉异常的患者，应考虑行前斜角肌和中斜角肌切除术。另一方面，对于无颈部创伤史且症状局限于手臂和手部的患者，特别是那些有动脉或静脉供血不足体征的患者，建议行第一肋切除术。
