胸廓出口综合征的解剖学认识及治疗进展

发布时间：2019-02-11 17:33

【摘要】：胸廓出口综合征(Thoracic Outlet Syndrome,TOS)是指臂丛神经和锁骨下动、静脉在胸廓出口处受压而产生的以颈肩痛、手部麻木、肌肉萎缩等一系列症状和体征为主要表现的综合症。Peet(1956)首次伎用了胸廓出口征这个名称;Rob和Standeven(1958)正式单独地把臂从神经血管和锁骨下动静脉在胸廓出口处受压命名为胸廓出口综合征。在胸廓出口综合征中,以臂丛神经受压多见,血管受压少见;可以单独出现,也可联合出现。在臂丛神经受压中,以横跨第一肋骨的臂丛神经下干受压最易发生,因而临床症状常表现为臂丛神经下干受压型,约占75%,此类胸廓出口综合征称为典型病例。以往一直认为上干型胸廓出口综合征很少见,仅占胸廓出口综合征的4%～10%。其实该病在临床上很常见。认为少见的主要原因是将这类疾病归纳到神经根型颈椎病,这两个病变均是神经根受压,仅仅是受压部位相差数毫米至1～2cm,目前已经认识到前、中斜角肌是TOS形成的重要解剖基础,尤其是近来认识到前、中斜角肌起始部纤维的特点与上干型胸廓出口综合征密切相关。早在1860年Wilshire就提出了颈肋是压迫臂丛神经的原因;1947年Adson指出引起胸廓出口综合征的因素之一是颈部结构的异常,包括颈段较长、锁骨下动脉升高等因素;1948年Kirgis提出小斜角肌是造成臂丛神经下干受压的因素,以后通过Wright、Roos、Dellon、顾玉东等学者的深入研究,使我们今天对该病有了较全面深刻的认识。目前的一般观点为:对于TOS而言,斜角肌的病变及异常的束带是最常见的直接致病因素。1995年陈德松等在研究颈肩疼痛的解剖基础上,对30具60侧经福尔马林固定的成人尸体小斜角肌、前中斜角肌的起始部进行解剖研究,并对53例胸廓出口综合征手术患者随访情况进行总结分析。发现小斜角肌的出现率为88.3%,T_1神经根或其下干在小斜角肌近段起源的腱性组
[Abstract]:Thoracic outlet syndrome (Thoracic Outlet Syndrome,TOS) refers to brachial plexus nerves and subclavian arteries and veins compressed at the thoracic outlet resulting from neck and shoulder pain and numbness of the hand. . Peet (1956, a series of symptoms and signs such as muscular atrophy, first used the name chest exit sign; Rob and Standeven (1958) formally named the thoracic outlet syndrome as the compression of the arm from the nerve vessels and subclavian arteries and veins at the thoracic outlet. In thoracic outlet syndrome, brachial plexus compression is more common than vascular compression; it can occur alone or in combination. In the compression of brachial plexus nerve, the inferior trunk of brachial plexus which straddles the first rib is the most likely to occur, so the clinical symptoms are often presented as brachial plexus inferior trunk compression type (about 75%). This type of thoracic outlet syndrome is a typical case. In the past, the upper trunk thoracic outlet syndrome was thought to be rare, accounting for only 4 / 10 of the thoracic outlet syndrome. In fact, the disease is very common clinically. It is believed that the main reason for this rarity is to sum up this kind of disease to the cervical spondylopathy of the nerve root type. These two diseases are both nerve root compression, the difference is only a few millimeters to 1 ~ 2 cm. The middle scalene muscle is an important anatomical basis for the formation of TOS. Recently, it has been recognized that the characteristics of the initial fiber of the middle scalene muscle are closely related to the superior trunk type thoracic outlet syndrome. As early as 1860, Wilshire proposed that the cervical rib was the cause of compression of the brachial plexus nerve, and Adson pointed out in 1947 that one of the factors causing thoracic outlet syndrome was the abnormal neck structure, including the longer neck segment and the elevation of the subclavian artery, etc. In 1948, Kirgis proposed that the scalene muscle was the cause of the compression of the inferior trunk of the brachial plexus. Later, through the in-depth study of Wright,Roos,Dellon, Gu Yudong and other scholars, we have a more comprehensive and profound understanding of the disease today. The current general view is that for TOS, the pathological changes of the scalene muscle and abnormal band are the most common direct pathogenic factors. In 1995, Chen Desong and others studied the anatomic basis of neck and shoulder pain. 30 adult cadavers with 60 sides fixed by formalin were dissected from the origin of the anterior and middle scalene muscles, and 53 patients with thoracic outlet syndrome were followed up. It was found that the occurrence rate of the scalene minor muscle was 88.3 / T / T = 88.3% respectively. 1 the tendons of the nerve root or its inferior trunk originated in the proximal segment of the scalene minor muscle.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R655;R322

【参考文献】