胸廓出口综合征的新认识——解剖学与临床观察

目的探讨胸廓出口综合征的病因。方法对３０具６０侧经福尔马林固定的成人尸体小斜角肌及前中斜角肌的起始部进行解剖研究;对５３例胸廓出口综合征手术患者（１９６６～１９９４年４５例,１９９６～１９９７年８例）随访情况进行总结分析。结果解剖研究发现小斜角肌的出现率为８８３％,Ｔ１神经根或其下干在小斜角肌近段起源的腱性组织上跨过;前中斜角肌在颈椎横突的前后结节均有起点,Ｃ５、Ｃ６神经根从前中斜角肌的交叉腱性起点中穿过。４５例１９６６～１９９６年手术者中,有颈肩痛症状者３４例,术后１７例颈肩痛症状仍存在,其中７例加重;８例１９９６～１９９７年手术者中,７例有颈肩痛,术中切断前中斜角肌在Ｃ５～６神经根旁的腱性纤维组织,术后仅有１例仍有颈肩部不适。结论小斜角肌的腱性纤维是臂丛神经下干或Ｔ１神经根受压的原因;前中斜角肌在Ｃ４～５横突前后结节的交叉腱性起点是压迫Ｃ５～６,有时包括Ｃ７神经根或臂丛神经上（中）干的原因

Anatomical study and clinical observation of thoracic outlet syndrome

Objective To investigate the etiology of thoracic outlet syndrome(TOS) from the point of anatomical and clinical view. Method Anatomical study was made on both sides of 30 cadavers. The minimus scalene muscle and the insertions of anterior and middle scalene muscle were dissected and observed. Clinically, 45 cases of thoracic outlet syndrome(TOS) were treated and followed up. Result The minimus scalene muscle was found in 88.3% of the cadavers. T 1 nerve root or the lower trunk of brachial plexus crossed the first rib just over the proximal tendinous part of minimus scalene muscle. Of 45 cases of TOS 34 presented neck shoulder pain 17 had. Unchanged symptoms postoperatively, and 7 had aggravated symptoms. Of the recent 8 cases of TOS, 7 presented neck shoulder pain. However, the symptom remained in only case after the resection of the tendinous tissue around 5,6 nerve root from anterior and middle scalene muscle. Conclusion The tendinous tissue of minimus muscle is the cause of the compression of T 1 nerve root or the lower trunk of the brachial plexus. The crossed tendinous origins from the anterior and posterior tubercle of C 4,5 transverse process is the cause of the compression of C 5,6 nerve root or the upper trunk of brachial plexus.