胸廓出口综合征手术治疗中对前中小斜角肌的处理

Surgical treatment of thoracic outlet syndrome :management of anterior ,medium and minimus scalenus muscles

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 2 8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 2 6例 2 7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。

Objective To evaluate surgical treatment outcome of thoracic outlet syndrome in 35 cases. Methods 37 sides in 35 cases thoracic outlet syndrome were involved in the study, with upper trunk type 5 cases, lower trunk type 30 sides in 28 cases, whole brachial plexus type 2 cases. Radiological examination showed cervical rib in 1 case and elongated transverse process of the seventh cervicals in 3 cases. The elongated bone and the first rib was resected . Surgical finding showed brachial plexus was compressed by fibrous band in 35 cases. Transection of anterior,medium and minimus scalenus muscles was done. Postoperative follow up ranged from 1 year to 3 .5 years. Results There were significant improvement of symptoms in 27 sides (26 cases),partial improvement in 6 sides(5 cases), inefficacy 4 cases.Conclusions Scalenus muscle was a main contributing factor of brachial plexus nerves and vessels compression syndrome. Transection of anterior, medium and minimus scalenus muscles should be routinely performed when surgical exploration was done.