手术治疗胸廓出口综合征疗效分析  

Efficacy analysis of surgical treatment on thoracic outlet syndrome

作　　者：李伟[1] 冯小辉 胡晓宇 曹能力[1] 陈亚伟[1] 刘建惠[1] LI Wei;FENG Xiao-hui;HU Xiao-yu;CAO Neng-li;CHEN Ya-wei;LIU Jian-hui(Department I of Hand and Microsurgery,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院手外科显微骨科Ⅱ,郑州450052

出　　处：《医药论坛杂志》2023年第10期49-51,56,共4页Journal of Medical Forum

摘　　要：目的 探讨前、中斜角肌切断术,结合第一肋骨或颈肋部分切除术治疗胸廓出口综合征(thoracic outlet syndrome, TOS)的方法和临床疗效。方法 2014年7月至2022年2月郑州市骨科医院收治胸廓出口综合征患者10例,其中神经型8例,血管型2例。其中1例神经型X线片示颈肋,1例神经型和2例血管型存在第1肋升高压迫臂丛神经血管。术中10例均作前、中斜角肌切断;3例第1肋骨升高压迫臂丛神经血管者同时切除第一肋骨部分骨质,颈肋骨质切除1例。术后的疗效作远期随访。术后随访1~8年,平均为2.7年。以症状、体征有无复发以及是否恢复原工作为随访主要观察指标。疗效按胸廓出口综合征评定标准评定,记录临床症状改善情况,运动、两点辨别觉、握力、肌肉萎缩恢复情况、血管试验、肌电图、是否恢复原工作等情况。结果 术后10例病人症状均明显改善,其中症状完全消失,运动、两点辨别觉、握力恢复正常,血管试验阴性,肌肉萎缩及肌电图改善明显,能胜任原来工作、日常生活恢复正常者7例;残留部分临床症状,运动及握力等基本恢复正常,不影响原来工作3例,优良率为100%。结论 对于症状较重的胸廓出口综合征,前、中斜角肌切断术,结合第一肋骨或颈肋部分切除术是一种确切有效的治疗方法。Objective To explore the method and clinical effect of anterior and middle scalene muscle resection combined with partial resection of the first rib or neck rib in the treatment of thoracic outlet syndrome.Methods From July 2014 to February 2022,10 cases of thoracic outlet syndrome were treated,including 8 cases of nerve type and 2 cases of vascular type.Among them,1 case of nerve type X-ray showed cervical rib,1 case of nerve type and 2 cases of vascular type had elevated first rib oppressing brachial plexus nerves and vessels.The anterior and middle scalene muscles were cut off in 10 cases,the first rib was cut off in 3 cases and the neck rib was cut off in 1 case.Long-term follow-up was performed.Postoperative follow-up ranged from 1 to 8 years with an average of 2.7 years.The main observation items were recurrence of symptoms and signs and whether to resume the original work.The curative effect was evaluated according to the evaluation standard of thoracic outlet syndrome,and the improvement of clinical symptoms was recorded,exercise,two-point discrimination,grip strength,muscle atrophy recovery,vascular test,electromyography and whether to restore the original work.Results After operation,the symptoms of 10 patients were obviously improved,including complete disappearance of symptoms,normal movement,two-point discrimination and grip strength,negative vascular test,obvious improvement of muscular atrophy and electromyography,7 cases were competent for their original work and daily life,and the remaining clinical symptoms,movement and grip strength were basically restored to normal without affecting the original work in 3 cases,the excellent and good rate was 100%.Conclusion For thoracic outlet syndrome with severe symptoms,anterior and middle scalene muscle resection combined with partial resection of the first rib or neck rib is an effective treatment.

关 键 词：胸廓出口综合征 臂丛神经 斜角肌切断 肋骨 卡压 手术 

分 类 号：R655[医药卫生—外科学]