神经型胸廓出口综合征的临床观察和分析--诊断和鉴别诊断

Clinical observation and analysis of neurogenic thoracic outlet syndrome——diagnosis and differential diagnosis

目的探讨神经型胸廓出口综合征(thoracic outlet syndrome,TOS)的诊断和鉴别诊断。方法自2013年1月至2018年8月,我们共诊断神经型TOS患者97例98侧,并进行臂丛神经松解手术,术前详细记录患肢感觉、肌力变化情况,术中观察记录臂丛及其毗邻组织解剖结构,术后随访患肢恢复情况,以确认术前诊断正确与否。从而分析神经型TOS的临床特点,总结诊断依据,并结合误诊病例分析其鉴别诊断。结果本组中86例87侧术后患肢感觉、肌力不同程度改善,证实术前诊断正确。其中涉及下干的84例85侧均有手和前臂肌肉萎缩,前臂内侧皮肤感觉改变。本组患者血管试验的阳性率高。术后确认误诊者11例,证实为肿瘤3例、臂丛神经炎4例、中枢神经病变4例。结论对TOS正确的诊断主要依赖准确的解剖知识、详细的病史和全面的体格检查。TOS患者中血管试验的作用应予重视,辅助检查对神经型TOS的鉴别诊断意义较大。

Objective To investigate the diagnosis and differential diagnosis of neurogenic thoracic outlet syndrome(TOS).Methods From January 2013 to August 2018,we diagnosed 97 patients(98 sides)with neurogenic TOS and performed brachial plexus release surgery.The changes of sensation and muscle strength of the affected limb were recorded in detail before operation,the anatomical structure of the brachial plexus and its adjacent tissues were observed and recorded during operation,and the recovery of the affected limb was followed up after operation to confirm whether the diagnosis was correct before operation.The clinical characteristics of neurogenic TOS were analyzed,the diagnosis basis was summarized,and the differential diagnosis was analyzed combined with misdiagnosed cases.Results The sensation and muscle strength of 87 sides of 86 patients were improved in varying degrees,which confirmed that the preoperative diagnosis was correct.Among them,85 sides of 84 cases involving the lower trunk had muscle atrophy of the hand and forearm,and the skin sensation of the medial forearm changed.The positive rate of vascular test was high in this group.11 cases were misdiagnosed,including 3 cases of tumor,4 cases of brachial plexus neuritis and 4 cases of central neuropathy.Conclusion The correct diagnosis of TOS mainly depends on accurate anatomical knowledge,detailed medical history and comprehensive physical examination.The role of vascular test in TOS patients should be paid attention to,and auxiliary examination is of great significance in the differential diagnosis of neurogenic TOS.