胸廓出口综合征的病理解剖因素观察和分析

Observation and analysis of pathoanatomical factors of thoracic outlet syndrome

目的从病理解剖方面分析胸廓出口综合征(thoracic outlet syndrome, TOS)的发生原因。方法对自2013年1月至2018年8月经过我们手术治疗证实为TOS的患者97例98侧, 将臂丛神经探查松解术中观察到的臂丛及其邻近组织形态记录下来, 与病史、术前检查、术后效果结合, 分析这些毗邻组织如何造成臂丛卡压。结果术后本组97例患者中86例症状改善, 11例无明显改善。症状改善的86例患者中54例55侧术中明确看到小斜角肌解剖异常, 包括起点抬高和/或腱性化;67例在颈_(8)、胸_(1)椎间孔出口可见异常纤维束带, 这些异常束带可分为腱性和纤维性, 明显影响下干活动度或直接造成下干卡压;4例青少年患者同时看到小斜角肌异常和腱性束带存在。结论异常的小斜角肌和异常束带是造成下干型TOS的主要因素, 年轻患者的这些异常更为明显, TOS的手术应以锁骨上入路切断这些异常结构松解臂丛为主。

Objective To explore the causes of thoracic outlet syndrome(TOS)from the aspect of pathological anatomy.Methods For 97 patients(98 sides)with TOS confirmed by our surgical treatment from January 2013 to August 2018,the morphology of brachial plexus and its adjacent tissues observed during brachial plexus exploration and release were recorded,combined with medical history,preoperative examination and postoperative effect,to analyze how these adjacent tissues cause brachial plexus compression.Results Among the 97 patients in this group,86 had improved symptoms and 11 had no significant improvement.Among the 86 patients with improved symptoms,55 sides of 54 patients clearly saw anatomical abnormalities of scalenus minimus muscle during operation,including elevation of starting point and/or tendinous degeneration.Sixtyseven cases showed abnormal fibrous bands at the outlet of Cg and T,intervertebral foramen.These abnormal bands can be divided into tendon and fibrous,which significantly affected the mobility of the lower trunk or directly caused the compression of the lower trunk.The abnormality of scalenus minimus muscle and the presence of tendinous band were observed in 4 adolescent patients at the same time.Conclusion The abnormal scalenus minimus muscle and abnormal band are the main factors causing lower trunk TOS,especially in young patients.The operation of TOS should mainly cut off these abnormal structures through supraclavicular approach and release the brachial plexus.