经典与改良斜角肌切断术治疗胸廓出口综合征疗效的长期随访

Long-term outcome of thoracic outlet syndrome: a comparison of classic and modified scalenectomy

目的比较经典及改良的斜角肌切断术治疗胸廓出口综合征(thoracic outlet syndrome,TOS)的远期疗效。方法对1985-1994年TOS 26例29侧行经典斜角肌切断术,1996-2000年TOS 28例30侧行改良斜角肌切断术的患者进行长期随访(5～19年)。分别测定手部肌力、手及前臂尺侧感觉、颈肩部不适及患肢血运等情况。结果经典与改良方法对手内肌萎缩、前臂及手尺侧感觉减退的缓解率分别为80．0%、80．8%、88．5和88．8%、85．2%、92．0%,两组差异无统计学意义；经典与改良方法对患肢发冷、发白以及颈肩部不适的缓解率较低,分别为47．1%、44．4%和80．0%、78．9%,两组相比差异有统计学意义(P＜0．05)。结论改良的斜角肌切断术能更好地缓解TOS的各种症状,尤其对颈肩部不适及患肢血运情况的改善疗效明显好于经典方法。

Objective With follow-up of surgically treated thoracic outlet syndrome （TOS） for longer than 5 years, results of classic and modified scalenectomy were compared. Methods 29 sides of TOS in 26 patients treated from 1985 to 1994 underwent classic scalenectomy （division of the anterior and middle scalenius muscles plus excision of the cervical rib or prolonged C7 transverse process if existed）. From 1996 to 2000, 30 sides of TOS in 28 patients were treated with modified scalenectomy （division of the anterior, middle, and minimal scalenius muscles plus adventitia stripping of the subclavicular artery and neurolysis of the lower trunk if there existed cold intolerance and pale of the limb）. Atrophy of the intrinsic muscles, numbness at the ulnar side of the hand and forearm, discomfort of the shoulder and neck region, cold and pale of upper extremities were assessed pre-and post-operatively in these 2 groups. Follow-up ranged from 5 to 19 years. Results The improvement rate for atrophy of the intrinsic muscles, numbness at the ulnar side of the hand and forearm in the classic group and modified group were 80.0%/88,8% ,80.8%/85.2%, 88.5%/92.0% respectively. There was no significant difference between the two groups. The improvement rate for discomfort of the shoulder and neck region, cold and pale of upper extremities in the classic group and modified group were 47.1%/80.0%, 44.4%/78.9% respectively. The difference between the two groups was statistically significant, Conclusion Compared with classic scalenectomy, modified scalenectomy had higher improvement rate for TOS symptoms, especially for diacomfort of the shoulder and neck region, and cold and pale of upper extremities.