切断前中小斜角肌治疗胸廓出口综合征的远期疗效

Long-term results of treatment of thoracic outlet syndrome by resection of the scalenus muscles

目的远期随访切断前中斜角肌治疗胸廓出口综合征(thoracic outlet syndrome,TOS)的疗效。方法对31例32侧胸廓出口综合征患者术后的疗效作远期随访。其中上干型4例,下干型26例27侧,全臂丛型1例。X线片示颈肋1例,第七颈椎横突过长2例。均行手术治疗。术中发现31例均有纤维束带压迫臂丛神经,作前、中、小前斜角肌切断术；3例骨异常者同时切除增长的骨组织和颈肋。术后随访4年8个月～8年3个月,平均为5年4个月。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项目。疗效按胸廓出口综合征评定标准评定。结果术后症状明显改善15例16侧,部分改善6例,无效10例。优良率为68．7%。结论该组病例远期疗效的优良率为68．7%,因此,胸廓出口综合征的治疗方法仍是个有待于进一步研究的临床课题。

Objective The post-operative results of thoracic outlet syndrome （TOS） treated by resection of the scalene muscles was reported. Methods 32 sides of 31 cases of thoracic outlet syndrome were surgically treated. 4 cases of them were upper trunk TOS, while 27 sides of 26 cases were lower trunk and 1 case was whole trunk TOS. The cervical rib was seen in 1 case and prolonged transverse process of the 7th cervical vertebrae was found in 2 cases. The prolonged transverse process of C7, cervical rib and the scalene muscles （including anterior, middle and minimal scalene muscles） were resected, All the cases were followed-up for 4 years 8 months to 8 years 3 months, with an average of 5 years 4 months. Recurrence of symptoms and return to original work were the evaluated, Results Remarkable alleviation of the symptoms and signs was reported in 16 sides of 15 cases, while partial improvement in 6 cases, Symptoms and signs remained unchanged in 6 cases. The overall effective rate was 68,7 % , Conclusion long-term outcome of surgically treated TOS was found to be effective in only 68.7% of the series. More optimal procedures shall be investigated.