Efficacy of Supraclavicular Scalenotomy Followed by External Neurolysis without Rib Resection for Post-traumatic Neurogenic Thoracic Outlet Syndrome
Efficacy of Supraclavicular Scalenotomy Followed by External Neurolysis without Rib Resection for Post-traumatic Neurogenic Thoracic Outlet Syndrome
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锁骨上斜角切开术继之以不切除肋骨的外部神经松解术治疗创伤后神经源性胸廓出口综合征的疗效
DOI：
10.1097/brs.0000000000003859
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发表时间：
2021
期刊：
影响因子：
3
通讯作者：
Tetsuya Yoshizumi
中科院分区：
文献类型：
--
作者：
山田 茂樹;石川 正恒;伊藤 広貴;武石 直樹;大谷 智仁;和田 成生;渡邉 嘉之;大島 まり;野崎 和彦;Tetsuya Yoshizumi
研究设计：连续病例系列。目的：我们的目的是评估在创伤后NTOS患者接受锁骨上斜角肌切开术后，在不切除肋骨的情况下进行外部神经松解术的结果。背景资料概要：神经源性胸廓出口综合征（NTOS）占所有TOS患者的95%以上，大多数NTOS患者在症状出现前有外伤史。方法：对患者行锁骨上斜角肌切开术和神经松解术，不切除肋骨回顾性分析2014年9月至2019年12月的病历和手术记录。评估患者的特征、治疗前的临床症状、手术结果以及短期和长期结果。为了评估术后2个月（短期结局）和12个月后（长期结局）的临床结局，我们根据改良的Odom标准对术后患者的主观评价进行了4级分类（极好、良好、一般和差）。优秀和良好被定义为一个成功的outcome.Results.96锁骨上斜角肌切开术不切除肋骨的创伤后NTOS患者进行。最常见的术中观察结果是86例（89.6%）的前斜角肌内纤维带。术后2个月96例患者主观评价的短期结果显示成功率为96.9%（优+良）。在85例术后随访超过12个月的患者中，基于患者在最后一次临床随访时的主观评价作为长期结果的成功率为74.1%。结论：在创伤后NTOS中，据报道手臂和手的症状是由于臂丛神经受压，这可能源于受伤后的肌肉肿胀，后来又源于疤痕肌肉的紧绷。考虑到这一机制和我们的研究结果，我们得出结论，锁骨上斜角肌切开术和外部神经松解术没有肋骨切除是有意义的，因为它们是非常有效的，足以改善NTOS.Level的症状证据：5胸廓出口综合征（TOS）是由通过胸廓入口的神经血管结构的撞击。TOS分为三大类：动脉性、静脉性和神经性。这些亚型的发生是由于斜角肌、第一肋骨或纤维带压迫臂丛神经、锁骨下静脉和锁骨下动脉。1
Study Design.Consecutive case series.Objective.Our aim was to evaluate the outcomes of patients who underwent supraclavicular scalenotomy followed by external neurolysis without rib resection for post-traumatic NTOS.Summary of Background Data.Neurogenic thoracic outlet syndrome (NTOS) comprises over 95% of all TOS patients, and most patients with NTOS have a history of trauma before the onset of their symptoms.Methods.Patients treated with supraclavicular scalenotomy and neurolysis without rib resection from September 2014 to December 2019 were retrospectively reviewed by using the medical records and operative notes. Patient's characteristics, clinical symptoms before treatment, operative findings, and short-and long-term outcomes were assessed. To assess clinical outcomes at 2 months after surgery (short-term outcomes) and 12 months later (long-term outcomes), we used a 4-grade categorization (Excellent, Good, Fair, and Poor) of patients’ subjective evaluations after surgery on the basis of modified Odom's criteria. Excellent and Good were defined as a successful outcome.Results.Ninety-six supraclavicular scalenotomies without rib resection were performed on patients with post-traumatic NTOS. The most common intraoperative observation was the fibrous bands within the anterior scalene muscle in 86 cases (89.6%). The short-term outcome with patients’ subjective evaluation in 96 operations at 2 months after surgery showed a 96.9% success rate (Excellent+ Good). In 85 cases followed for more than 12 months after surgery, the success rate based on patients’ subjective evaluation at the last clinic follow-up appointment as a long-term outcome was 74.1%.Conclusion.In post-traumatic NTOS, it has been reported the arm and hand symptoms are due to pressure on the brachial plexus, which can stem from the swollen muscle following injuries and later from tightness of the scarred muscle. Considering this mechanism and our results, we concluded that supraclavicular scalenotomy and external neurolysis without rib resection made sense, as they were very effective and adequate to improve symptoms of NTOS.Level of Evidence: 5Thoracic outlet syndrome (TOS) is caused by impingement of the neurovascular structures passing through the thoracic inlet. TOS is divided into three main categories: arterial, venous, and neurogenic. These subtypes occur due to compression of the nerves of the brachial plexus, the subclavian vein, and the subclavian artery by the scalene muscle, first rib, or fibrous band. 1
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DOI：
10.1007/3-211-27458-8_6
发表时间：
2005
期刊：
Acta neurochirurgica. Supplement
影响因子：
--
作者：
C. Schenardi
通讯作者：
C. Schenardi
胸廓出口综合征的治疗：不同手术的比较。
影响因子：
4.3
作者：
Richard J. Sanders;William H. Pearce
通讯作者：
William H. Pearce
胸廓出口受压综合征手术减压的长期结果。
DOI：
--
发表时间：
2001
期刊：
Journal of the Royal College of Surgeons of Edinburgh
影响因子：
--
作者：
CA Maxwell;B. Noorpuri;Haque Sa;Baker Dm;Lamerton Aj
通讯作者：
Lamerton Aj
胸廓出口综合征被过度诊断。
影响因子：
3.4
作者：
A. Wilbourn
通讯作者：
A. Wilbourn
经腋窝入路手术的胸廓出口综合征患者手术结果的临床预测因素。
DOI：
10.1016/j.ejcts.2003.11.021
发表时间：
2004
期刊：
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
影响因子：
--
作者：
Ş. Yavuzer;C. Atinkaya;O. Tokat
通讯作者：
O. Tokat