胸廓出口综合征的诊疗体会  

Diagnosis and surgical treatment of thoracic outlet syndrome

作　　者：于利[1] 张卫国[1] 鲁明[1] 

机构地区：[1]大连医科大学附属第一医院骨科,辽宁大连116011

出　　处：《实用手外科杂志》2005年第2期77-78,共2页Journal of Practical Hand Surgery

摘　　要：目的探讨胸廓出口综合征(TOS)的诊断和手术治疗。方法我院自1997～2003年诊断和手术治疗胸廓出口综合征23例24侧,诊断为臂丛上干型TOS2例,下干型17例18侧,全臂丛型1例,血管型2例,混合型1例。手术切除颈肋及过长的横突,同时作臂丛神经外膜松解术。术中发现23例有纤维束带压迫臂丛神经,均切断前斜角肌,松解臂丛神经及受压的锁骨下血管,如果发现中、小斜角肌压迫臂丛神经血管,则予切断。术后当天行颈肩部活动。结果按Ross的疗效评定标准评定疗效,本组优10例11侧,良9例,可2例,差2例,优良率83.33%。结论胸廓出口综合征应早期手术探查,彻底松解臂丛神经血管。Objective To investigate the diagnosis and surgical treatment of thoracic outlet syndrome.Methods From 1997 to 2003, 23 patients with thoracic outlet syndrome were diagnosed and undergone surgery. There were 2 cases of upper trunk type, 18 sides in 17 cases of lower trunk type, 1 cases of whole brachial plexus type, 2 cases of vascular type and 1 cases of combined type in this study.Transection of cervical rib and the elongated transverse process of the seventh cervicals and lysis of epineurium brachial plexus were done .Surgical finding showed that brachial plexus was compressed by fibrous band in 23 cases.Then all cases underwent transection of anterior scalenus muscles, and some cases additionally underwent transection of medium and minimus scalenus muscles in order to resolve the neurovascular compression.Exercise of neck and shouder should be done just after operation on the same day.Results Acccording to Ross criterion, the results of treatment were evaluated as excellent in 10 cases and 11 sides, good in 9 cases, fair in 2 cases and poor in 2 cases.The percent of excellent and good surgical outcomes was 83.33%.Conclusion Early surgical exploration and thorough lysis of brachial plexus nerves and vessels should be early done when treating thoracic outlet syndrome.

关 键 词：胸廓出口综合征 臂丛神经 TOS 手术方法 临床症状 颈部臂丛神经血管受压征 

分 类 号：R651.3[医药卫生—外科学]