Stallworth J M, Quinn G J, Aiken A F
Ann Surg. 1977 May;185(5):581-92. doi: 10.1097/00000658-197705000-00011.
Between 1966 and 1975, 425 patients with thoracic outlet symptoms were studied: 146 operative procedures were carried out in 103 of these patients. Division of soft tissues, only, in 129 cases offered relief of symptoms. In 10 cases bone resections (four cervical ribs, one second rib, one clavicle, and four first ribs) were done in an attempt to relieve the outlet problems. Preoperative evaluation included neurological consultation, x-rays of the neck and chest, detailed non-invasive oscillographic recordings of arterial flow during various outlet maneuvers, angiograms and in many instances electromyograms and nerve conduction studies. The axillary surgical approach to be various compression areas was preferred in that hyperabduction of the arm and costoclavicular maneuvers could be carried out under direct observation of the involved vessels. Accurate appraisal of the compression point could be assessed before and after the involved structure was divided or removed. Complications were limited to two hematomas postoperatively, and transient paralysis of the diaphragm in one patient. In all patients the vessel compression was relieved at the time of operation. In no instance was the first rib emperically removed as a "cure all" procedure. Six months following operation, patients were reevaluated and all except 8 patients (11 operative procedures) had relief of symptoms for a success rate of 92.5%.
1966年至1975年间，对425例有胸廓出口综合征症状的患者进行了研究：其中103例患者接受了146次手术。仅对129例患者进行软组织松解术，症状得到缓解。10例患者进行了骨切除术（4例切除颈肋，1例切除第二肋，1例切除锁骨，4例切除第一肋），试图缓解胸廓出口问题。术前评估包括神经科会诊、颈部和胸部X光检查、在各种胸廓出口动作期间详细的无创动脉血流示波记录、血管造影，在许多情况下还包括肌电图和神经传导研究。首选腋窝手术入路处理各个受压区域，因为在直视受累血管的情况下可以进行手臂过度外展和肋锁动作。在受累结构被分离或切除之前和之后，可以评估压迫点。并发症仅限于术后2例血肿，1例患者出现膈肌短暂麻痹。所有患者在手术时血管压迫均得到缓解。没有一例将第一肋作为“万能”手术经验性切除。术后6个月对患者进行复查，除8例患者（11次手术）外，所有患者症状均得到缓解，成功率为92.5%。
