Dubuisson A S, Kline D G, Weinshel S S
Department of Neurosurgery, Louisiana State University Medical Center, New Orleans.
J Neurosurg. 1993 Sep;79(3):319-30. doi: 10.3171/jns.1993.79.3.0319.
A 15-year operative experience with 105 posterior subscapular approaches to the brachial plexus in 102 patients is presented. The procedure is indicated in carefully selected cases, especially where the proximal portions of lower spinal nerves are involved. Its main advantage is proximal exposure of the plexus spinal nerves, particularly at an intraforaminal level. The indications in this series were thoracic outlet syndrome (TOS) in 51 carefully selected procedures, brachial plexus tumor involving proximal roots in 22 patients, post-irradiation brachial plexopathy in 14 cases, and proximal traumatic brachial plexus palsy in 18 patients. Thoracic outlet syndrome associated with neurological loss, recurrent TOS after a prior operation, or proximal brachial plexus surgical lesions involving the spinal nerve(s), especially at an intraforaminal level, can be approached advantageously by such a posterior subscapular approach. The technique should also be considered when prior operation, trauma, or irradiation to the neck or anterior chest wall make a posterior exploration of the plexus easier than an anterior one. Anterior exposure of the plexus is the preferable approach for the majority of lesions needing an operation, but the posterior subscapular procedure can be useful in well-selected cases.
本文介绍了102例患者采用105次肩胛下后路臂丛神经手术的15年手术经验。该手术适用于经过精心挑选的病例，特别是涉及下脊神经近端部分的情况。其主要优点是能在近端暴露臂丛神经的脊神经，尤其是在椎间孔水平。本系列中的适应证包括：51例精心挑选的胸廓出口综合征（TOS）手术、22例涉及近端神经根的臂丛神经肿瘤、14例放疗后臂丛神经病变以及18例近端创伤性臂丛神经麻痹。伴有神经功能丧失的胸廓出口综合征、先前手术后复发的TOS或涉及脊神经（尤其是在椎间孔水平）的近端臂丛神经手术病变，可通过这种肩胛下后路手术进行有效处理。当先前的手术、创伤或颈部或前胸壁的放疗使臂丛神经的后路探查比前路探查更容易时，也应考虑采用该技术。对于大多数需要手术的病变，臂丛神经的前路暴露是首选方法，但肩胛下后路手术在精心挑选的病例中可能有用。
