陈德松 陈琳 顾玉东 200040上海医科大学附属华山医院手外科 中华骨科杂志 1999 0 19 4


    关键词：胸廓出口综合征解剖学外科手术 期刊 zhgkzz 0 临床研究 fur -->


    

【摘要 】目的在解剖学研究和临床分析的基础上提出了胸廓出口综合征手术方法的改良。方法30例尸体解剖，研究前、中、小斜角肌的起止点和臂丛神经的关系。随访了术后6个月～2年的19例有颈肩痛和手部麻木、肌肉萎缩的胸廓出口综合征患者，均做前、中斜角肌起点和小斜角肌切断术。结果前、中斜角肌在颈椎横突的前、后结节均有起点，C₅ 、C₆ 神经根穿过两肌的交叉肌纤维，C₈ 、T₁ 或下干跨越小斜角肌的腱性缘。随访的19例患者手麻、痛症状均消失。仅1例有颈部不适。结论前、中斜角肌的起点和小斜角肌是产生胸廓出口综合征的主要原因，切断前、中斜角肌的起点和小斜角肌是手术治疗胸廓出口综合征的良好方法。

    Modified Operation ofThoracic Outlet Syndrome

CHEN Desong,CHEN Lin,GU Yudong.De-partment of HandSurgery,Huashan Hospital,Shanghai Medical University,Shanghai 200040

【Abstract 】Objective To modify theoperation method for thoracic outlet syndrome based on the anatomic dissection andclinical analysis.Methods Anatomical study was done on both sides of 30 ca-davers.Theorigin and insertion of anterior,middle and smallest scalene muscles,as well as theirrelations to brachial plexus were observed.Nineteen cases of thoracic outlet syndrome weretreated by resection of anterior and middle scalene muscles at the origin,smallest scalenemuscle was also cut.Results An-terior and middle scalene muscles originated from bothanterior and posterior tubercle of cervical transverse process.C₅ and C₆ nerve roots might be pinched by the cross origin muscle fibers.Of 19 cases undergoneresection of the anterior and middle scalene muscles at their origin,18 had excellentresults after 6 months to 2 years follow-up.Conclusion Anterior,middle and smallestscalene muscles are the main cause of thoracic outlet syndrome;anterior and middle scalenemuscles should be resected from their origins,smallest scalene muscle should be cut aswell.

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