【摘要】：胸廓出口綜合征(Thoracic Outlet Syndrome,TOS)是指臂叢神經(jīng)和鎖骨下動、靜脈在胸廓出口處受壓而產(chǎn)生的以頸肩痛、手部麻木、肌肉萎縮等一系列癥狀和體征為主要表現(xiàn)的綜合癥。Peet(1956)首次伎用了胸廓出口征這個名稱;Rob和Standeven(1958)正式單獨地把臂從神經(jīng)血管和鎖骨下動靜脈在胸廓出口處受壓命名為胸廓出口綜合征。 在胸廓出口綜合征中,以臂叢神經(jīng)受壓多見,血管受壓少見;可以單獨出現(xiàn),也可聯(lián)合出現(xiàn)。在臂叢神經(jīng)受壓中,以橫跨第一肋骨的臂叢神經(jīng)下干受壓最易發(fā)生,因而臨床癥狀常表現(xiàn)為臂叢神經(jīng)下干受壓型,約占75%,此類胸廓出口綜合征稱為典型病例。以往一直認為上干型胸廓出口綜合征很少見,僅占胸廓出口綜合征的4%～10%。其實該病在臨床上很常見。認為少見的主要原因是將這類疾病歸納到神經(jīng)根型頸椎病,這兩個病變均是神經(jīng)根受壓,僅僅是受壓部位相差數(shù)毫米至1～2cm,目前已經(jīng)認識到前、中斜角肌是TOS形成的重要解剖基礎(chǔ),尤其是近來認識到前、中斜角肌起始部纖維的特點與上干型胸廓出口綜合征密切相關(guān)。 早在1860年Wilshire就提出了頸肋是壓迫臂叢神經(jīng)的原因;1947年Adson指出引起胸廓出口綜合征的因素之一是頸部結(jié)構(gòu)的異常,包括頸段較長、鎖骨下動脈升高等因素;1948年Kirgis提出小斜角肌是造成臂叢神經(jīng)下干受壓的因素,以后通過Wright、Roos、Dellon、顧玉東等學者的深入研究,使我們今天對該病有了較全面深刻的認識。目前的一般觀點為:對于TOS而言,斜角肌的病變及異常的束帶是最常見的直接致病因素。1995年陳德松等在研究頸肩疼痛的解剖基礎(chǔ)上,對30具60側(cè)經(jīng)福爾馬林固定的成人尸體小斜角肌、前中斜角肌的起始部進行解剖研究,并對53例胸廓出口綜合征手術(shù)患者隨訪情況進行總結(jié)分析。發(fā)現(xiàn)小斜角肌的出現(xiàn)率為88.3%,T_1神經(jīng)根或其下干在小斜角肌近段起源的腱性組
[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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2005
【分類號】：R655;R322

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