斜角肌切断术治疗胸廓出口综合征的临床疗效

目的 探讨斜角肌切断术治疗胸廓出口综合征的临床疗效.方法 2004年5月至2010年1月对胸廓出口综合征18例,其中上干型3例,下干型14例,交感型1例.X线照片示第7颈椎横突过长12例,颈肋2例,未见骨性异常4例,采用斜角肌切断术进行治疗.结果 术后随访6个月～5年4个月,症状明显改善9例,部分改善6例,自觉无改善3例.优良率83.3%.结论 斜角肌切断术治疗胸廓出口综合征的临床效果较好.     

斜角肌切断术治疗胸廓出口综合征的临床疗效

目的 探讨斜角肌切断术治疗胸廓出口综合征的临床疗效.方法 2004年5月至2010年1月对胸廓出口综合征18例,其中上干型3例,下干型14例,交感型1例.X线照片示第7颈椎横突过长12例,颈肋2例,未见骨性异常4例,采用斜角肌切断术进行治疗.结果 术后随访6个月～5年4个月,症状明显改善9例,部分改善6例,自觉无改善3例.优良率83.3%.结论 斜角肌切断术治疗胸廓出口综合征的临床效果较好.     

斜角肌切断术治疗胸廓出口综合征的临床疗效

目的 探讨斜角肌切断术治疗胸廓出口综合征的临床疗效.方法 2004年5月至2010年1月对胸廓出口综合征18例,其中上干型3例,下干型14例,交感型1例.X线照片示第7颈椎横突过长12例,颈肋2例,未见骨性异常4例,采用斜角肌切断术进行治疗.结果 术后随访6个月～5年4个月,症状明显改善9例,部分改善6例,自觉无改善3例.优良率83.3%.结论 斜角肌切断术治疗胸廓出口综合征的临床效果较好.     

经腋路第一肋切除治疗胸廓出口综合征

目的：总结经腋路第一肋切除治疗胸廓出口综合征的经验，方法：采用经腋路第一肋切除术治疗下臂丛型胸廓出口综合征16例，结果：3例术中胸膜破裂，术后有胸闷和胸前区压迫感，其中1例前胸部可摸到少量的皮下捻发音；X线片示均有轻度气胸，除吸氧外，未做其它处理，术后3d基本恢复。16例中1例在术后3个月复发，再次行前中斜角肌切除术，术后症状缓解，2例在术后8个月复发,4例在术后12个月出现前臂内侧和手尺侧轻度麻木及肩颈部不适，但比术前要轻得多；该6例经用药后症状基本消失，其余患者症状完全解除，未复发，总治愈率为81．25％，8例第一肌间背仙肌萎缩者，3例患者完全恢复（术后25－28个月），2例部分恢复（术后18－23个月），该5例的爪形手畸形均已消失，结论：经腋路切除第一肋治疗下臂丛型胸廓出口综合征，伤口隐蔽，损伤小，手术后复发率较低。     

10例上干型胸廓出口综合征诊治回顾性分析

目的 通过对10例上干型胸廓出口综合征(thoracic outlet syndrome,TOS)患者的诊治进行回顾性分析,探讨前中斜角肌起点切断治疗的疗效.方法 对10例明确诊断为上干型胸廓出口综合征患者在全身麻醉下行前中斜角肌起点切断,记录手术前后症状、体征和肌电图以及必要的辅助检查进行疗效分析,并与颈5、6椎间盘突出征病例进行鉴别诊断.结果 术后10例随访5～7年,平均6.2年.按顾玉东提出的臂丛神经上干功能评定标准评价:优5例,良3例,可2例.结论 明确上干型胸廓出口综合征的诊断标准,前中斜角肌起点切断效果满意.与颈5、6椎间盘突出征鉴别诊断明确.     

经腋路切除第一肋骨治疗胸腔出口综合征

我院1980～1983年应用经腋路切除第一肋骨治疗胸腔出口综合征4例,疗效良好。并改进了剥离第1肋骨上缘的器械,缩短了手术时间。现将诊治体会介绍如下。例1.女,35岁。2年来无明显诱因左上肢乏力,左手麻木,每当左侧卧位时上诉症状加剧。着凉和劳     

经椎板间隙入路完全内窥镜下椎间盘摘除术治疗L5/S1非包含型椎间盘突出症

目的:前瞻性研究经椎板间隙入路完全内窥镜下椎间盘摘除术治疗L5/S1非包含型椎间盘突出症的临床疗效.方法:2011年4月～2011年12月采用经椎板间隙入路完全内窥镜下L5/S1椎间盘摘除术治疗L5/S1椎管内非包含型椎间盘突出症患者72例,其中男36例,女36例;年龄18～78岁,平均40.5岁;脱出型51例,游离型21例.将椎管内L5/S1椎间盘非包含型突出按照突出物与同侧S1神经根的位置关系分为腋型(30例)、腹型(28例)及肩型(14例).对于腋型突出采用腋路,将内窥镜及工作套管直接置入S1神经根腋部进行脱出物及椎间盘内松动髓核的摘除;对肩型及腹型突出采用肩路,将内窥镜及工作套管置入S1神经根肩部进行手术.术后第2天及术后3个月复查腰椎MRI评估突出物切除的彻底性.记录术前、术后3个月、术后6个月及术后12个月的腰痛视觉模拟评分(visual analogue scales,VAS)、腿痛VAS及Oswestry功能障碍指数(Oswestry disability index,ODI)并比较术前及术后各时间点的统计学差异.评估术后12个月时MacNab腰椎功能评分及S1神经根功能状态.结果:手术均顺利完成,手术时间20～80min,平均45min.无神经损伤、感染及其他手术并发症.术后第2天复查MRI显示致压突出物完全切除率为100％.1例术后2个月椎间盘突出复发,采用显微内窥镜下椎间盘摘除术翻修;其余71例术后3个月腰椎MRI显示椎间盘后缘获良好塑形.术后各时间点腰痛VAS、腿痛VAS及ODI均较术前明显降低(P＜0.05).术后12个月时MacNab评分,优44例,良26例,可1例,差1例.术后1年随访S1神经根支配区感觉、肌力明显恢复(P＜0.01),跟腱反射无明显恢复(P＞0.05).结论:根据椎间盘突出部位选择腋路或肩路经椎板间隙完全内窥镜下椎间盘摘除术治疗L5/S1椎管内非包含型椎间盘突出症安全、合理,短期疗效较好.     

胸廓出口综合征的外科治疗

１９８０年至１９９３年间共收治胸廓出口综合征病人５５例，行经腋路切口胸出口松解术６２次，手术完全切断前，中斜角肌，切除带有骨膜的第一肋，松解锁骨下动脉和臂丛神经周围的纤维带，同时切除颈肋或过长的横突及其附着韧带，术后随访率为９６．４％，平均随访７．７年，结果良好８１．１％，改善１３．２％，无变化５．７％，无复发病例，作者认为经腋路切口胸出口松解术是治疗胸廓出口综合征较理想的术式。     

胸廓出口综合征诊治进展

臂丛神经血管受压征指臂丛神经尤其是下干和锁骨下动静脉在胸廓出口部位因各种原因受压 ,从而引起上肢和颈肩部疼痛、麻木、无力、感觉异常或肢端缺血为特征的证候群。Ｐｅｅｔ于 195 6年将其称为胸廓出口综合征 (Ｔｈｏｒａｃｉｃｏｕｔｌｅｔｓｙｎ ｄｒｏｍｅＴＯＳ)。由于缺乏客观的诊断标准 ,临床表现多样 ,易受病人主观因素的影响 ,现将近期国内外的研究进展综述如下。1　病因与分类胸廓出口综合征的病理基础是胸廓出口处骨性组织和软组织的解剖变异。骨性卡压约占 30 % [1] ,包括第 7颈椎横突过长 ,颈肋 ,第一肋骨变异 ,第一肋骨及锁…     

胸廓出口综合征

胸廓出口综合征是锁骨下动脉和/或静脉及臂丛神经在经过胸廓出口的第一肋骨和锁骨之间,受到骨或韧带的压迫所产生的一组神经或/和血管受压症候群.也有称之为第一肋骨综合征、颈助综合征、前斜角肌综合征、肋锁综合征、肩带压迫综合征及过度外展综合征等.     

在内窥镜辅助下手术治疗胸廓出口综合征10例报告

目的 报告并探讨一个治疗胸廓出口综合征(thoracic outlet syndrome，TOS)的新方法，即在内窥镜辅助下进行手术治疗。方法 局部麻醉下在颈外侧作1．5cm长的小切口，在内窥镜的辅助观察下，切断部分前中斜角肌的腱性起始纤维。结果 2092年3月11日至2002年12月16日，共作10例。手术当天10例的症状和体征均完全消失。术后随访4个月～1年，平均6个月。5例的症状和体征完全消失。4例的肌力恢复正常，前臂和小指的刺痛觉稍减退。1例仅偶有颈部不适的症状，术侧锁骨区有麻痛，针刺有痛觉过敏。结论 在内窥镜辅助下经颈部微小切口切断部分前中斜角肌的腱性起始纤维，可解除斜角肌对臂丛神经的压迫，是一个创伤很小的治疗胸廓出口综合征的新方法。     

胸廓出口综合征手术治疗中对前中小斜角肌的处理

目的随访35例胸廓出口综合征手术治疗的疗效。方法手术治疗35例37侧胸廓出口综合征患者,其中上干型5例,下干型28例30侧,全臂丛型2例。X线片示颈肋1例,第七颈椎横突过长3例。手术切除增长的骨组织和颈肋,术中发现35例均有纤维束带压迫臂丛神经,均作前、中、小前斜角肌切断术。术后随访1年～3年6个月。结果术后症状明显改善26例27侧,部分改善5例6侧,无效4例。结论斜角肌是引起臂丛神经血管受压征的主要因素,手术探查时应常规切断前、中斜角肌及小斜角肌。     

胸廓出口综合征的诊疗体会

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，诊断为臂丛上千型TOS2例，下千型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例，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。     

儿童胸廓出口综合征的诊断与治疗

目的探讨儿童胸廓出口综合征的诊断与治疗效果。方法分析5例儿童胸廓出口综合征患者手术治疗的临床资料。结果参考陈德松等的标准评定，优4例，良1例。结论儿童胸廓出口综合征主要病理改变是斜角肌的肥厚与挛缩，病因是包括感染在内的多种因素共同作用造成，一旦保守治疗无效应及早手术。     

First rib resection for vascular complications of thoracic outlet syndrome

The surgical approach to vascular complications of the thoracic outlet syndrome remains controversial. When present, removal of a cervical rib alone has produced disappointing results. Our experience of 29 consecutive first rib excisions over a 5-year period is presented. Of 20 cases with uncomplicated subclavian artery compression 19 were cured, and of six cases with aneurysm or thrombosis five were improved. Of 12 cases with neurological symptoms nine were cured and two were improved. It is suggested that first rib excision is the essential primary treatment for patients with arterial symptoms due to thoracic outlet syndrome.     

内镜辅助治疗周围神经卡压综合征

目的 探讨应用内镜技术辅助松解术治疗周围神经卡压综合征的临床效果.方法 2003年3月至2006年3月,收治44例周围神经卡压综合征患者,男19例,女25例;年龄24～67岁,平均37.6岁.对27例32腕腕管综合征患者中的7例8腕行Okutsu法手术,15例18腕行Chow法手术,5例6腕行皮肤牵引法腕管外镜下腕横韧带切断术;8例9肘肘管综合征和7例腓总神经卡压患者通过CO2 充气皮下气腔法内镜下行肘部尺神经松解前置术和腓总神经松解术;2例四边孔综合征患者用自制的组织撑开器内镜辅助下行腋神经松解术.术后进行疗效观察.结果 44例患者均在镜下顺利完成手术,无一例发生神经、血管损伤等并发症,切口1～3 cm,随访时间6～36个月,平均18.5个月.感觉功能在1～3个月内恢复,达S4级.43例患者运动功能在6～12个月内恢复至4～5级,未见复发病例;1例腓总神经卡压患者随访至24个月时,因伸踝、趾肌力恢复至2级停止而二期行肌腱转位术.除1例腓总神经卡压患者外,43例患者均于术后12个月复查肌电图,结果 显示神经传导速度正常,神经所支配肌肉重收缩呈单纯一混合相或混合相.结论 内镜辅助治疗部分周围神经卡压综合征安全实用,不仅能达到与常规开放手术相同的疗效,而且更微创、美观,但由于其手术适应证的局限性,开放手术仍是目前治疗周围神经卡压的常规方法 .     

同期手术治疗胸廓出口综合征合并远端神经卡压的疗效

目的探讨远近端同期手术治疗胸廓出口综合征合并远端神经卡压的疗效。方法对8例胸廓出口综合征合并远端神经卡压者,一期同时手术松解臂丛神经及远端神经卡压,并消除了全部卡压因素。结果按成效敏等的评定标准评价优3例,良4例,差1例。结论对晚期已出现肌萎缩的胸廓出口综合征合并远端神经卡压患者,应选择一期远近端神经同时松解术,以改善疗效、提高治愈率。     

Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up

Thoracic outlet syndrome is an often misdiagnosed syndrome which consists of a neurovascular compression at the upper thoracic outlet. The clinical presentation can be variable, ranging from mild symptoms to venous thrombosis and muscle atrophy. Many aetiologies, both congenital and acquired, related either to bony or soft tissue anomalies, have been associated with this syndrome. As a consequence, the diagnosis is often challenging and sometimes it can be obtained only with surgical exploration. Additionally, no specific clinical test is considered diagnostic of thoracic outlet syndrome. However, the recent advances in imaging techniques together with a careful clinical evaluation give the surgeon the chance to recognize the constricting anatomy before surgery in many cases. No standard surgical procedure has been identified; however, in literature the largest series have been treated with transaxillary first rib resection. Here we report our experience in the surgical treatment of this syndrome with a minimum follow-up of three years. Our approach consists of performing a supraclavicular decompression without routine first rib resection. This allows for identifying and removing the constricting anatomy in most cases, with satisfactory results in 96.9% of patients and a low complication rate.     

The rudimentary first rib. A cause of thoracic outlet syndrome with arterial compromise

The symptoms of thoracic outlet syndrome are neurologic, not vascular, in more than 95% of cases. Subclavian artery compression is usually related to cervical ribs; however, congenitally abnormal first ribs may also produce vascular compromise. We review our two cases of thoracic outlet syndrome associated with significant subclavian artery compression caused by rudimentary first ribs and the prior literature emphasizing the mechanism of injury, diagnostic features, and treatment. Transaxillary resection of the first and second ribs was curative in both cases. The operative specimens demonstrated fusion of the rudimentary first rib to the second rib, with compression of the subclavian artery by a large first-rib exostosis. Patients with thoracic outlet syndrome and a rudimentary first rib should be examined for substantial vascular compromise, and, if it is found, the abnormal first and second rib complex should be resected early without prolonged conservative measures.     

Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty

OBJECTIVE: Residual subclavian vein stenosis after thoracic outlet decompression in patients with venous thoracic outlet syndrome is often treated with postoperative percutaneous angioplasty (PTA). However, interval recurrent thrombosis before postoperative angioplasty is performed can be a vexing problem. Therefore we initiated a prospective trial at 2 referral institutions to evaluate the safety and efficacy of combined thoracic outlet decompression with intraoperative PTA performed in 1 stage. METHODS: Over 3 years 25 consecutive patients (16 women, 9 men; median age, 30 years) underwent treatment for venous thoracic outlet syndrome with a standard protocol at 2 institutions. Twenty-one patients (84%) underwent preoperative thrombolysis to treat axillosubclavian vein thrombosis. First-rib resection was performed through combined supraclavicular and infraclavicular incisions. Intraoperative venography and subclavian vein PTA were performed through a percutaneous basilic vein approach. Postoperative anticoagulation therapy was not used routinely. Venous duplex ultrasound scanning was performed postoperatively and at 1, 6, and 12 months. RESULTS: Intraoperative venography enabled identification of residual subclavian vein stenosis in 16 patients (64%), and all underwent intraoperative PTA with 100% technical success. Postoperative duplex scans documented subclavian vein patency in 23 patients (92%). Complications included subclavian vein recurrent thrombosis in 2 patients (8%), and both underwent percutaneous mechanical thrombectomy, with restoration of patency in 1 patient. One-year primary and secondary patency rates were 92% and 96%, respectively, at life-table analysis. CONCLUSIONS: Residual subclavian vein stenosis after operative thoracic outlet decompression is common in patients with venous thoracic outlet syndrome. Combination treatment with surgical thoracic outlet decompression and intraoperative PTA is a safe and effective means for identifying and treating residual subclavian vein stenosis. Moreover, intraoperative PTA may reduce the incidence of postoperative recurrent thrombosis and eliminate the need for venous stent placement or open venous repair.