Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome.

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Hiroshi Satake, Ryusuke Honma, Toshiya Nito, Yasushi Naganuma, Junichiro Shibuya, Masahiro Maruyama, Tomohiro Uno, Michiaki Takagi
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引用次数: 0

Abstract

Objectives: We have hypothesized that an endoscopically assisted transaxillary approach in the zero position would be able to improve visualization and allow safe surgery for thoracic outlet syndrome.

Methods: We performed surgery only for patients with certain objective findings, including blood flow disruption, low blood flow and accelerated blood flow in the subclavian artery demonstrated using Doppler sonography, narrowing of the scalene interval width between the anterior and middle interscalene muscles (interscalene base) or costoclavicular space demonstrated using Duplex ultrasonography or computed tomography angiography. The present study included 45 consecutive patients (50 limbs) who underwent endoscopic transaxillary first rib resection with scalenotomy and brachial plexus neurolysis. We assessed the intraoperative parameters, including the interscalene base, blood loss, operation time, patient satisfaction, preoperative and postoperative Quick Disability of the Arm, Shoulder and Hand and complications.

Results: The mean intraoperatively measured interscalene base width was 6.4 mm. All patients showed improvement after surgery. The outcome was excellent in 40% of cases, good in 48%, fair in 12% and poor in none. Pneumothorax was present in 6%. There were no other complications and no recurrences. Among patients who had been followed up for at least 2 years, the Quick Disability of the Arm, Shoulder and Hand score was significantly improved (42 before surgery vs 12 at final follow-up), especially in athletes relative to non-athletes (0.2 vs 16). The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes).

Conclusions: Endoscopically assisted transaxillary first rib resection and brachial plexus neurolysis in the zero position are useful and safe for thoracic outlet syndrome, especially in athletes.

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内窥镜辅助零位第一肋骨切除术治疗胸廓出口综合征的中期结果。
目的:我们假设内镜辅助下经腋窝零位入路可以提高胸廓出口综合征的可视性,并允许安全手术。方法:我们只对有一定客观表现的患者进行手术,包括多普勒超声显示的锁骨下动脉血流中断、低血流量和血流量加速,双工超声或计算机断层血管造影显示的前、中斜角肌间肌(斜角肌基底)或肋锁骨间隙狭窄。本研究包括45例连续患者(50条肢体),他们接受了经腋窝第一肋骨切除术,肩胛切除术和臂丛神经松解术。我们评估术中参数,包括斜角肌间基底、出血量、手术时间、患者满意度、术前和术后手臂、肩部和手部的快速失能及并发症。结果:术中测量的斜角间基底平均宽度为6.4 mm。所有患者术后均有改善。40%的病例结果为极好,48%为良好,12%为一般,没有一例为差。6%的患者有气胸。无其他并发症,无复发。在随访至少2年的患者中,手臂、肩膀和手的快速残疾评分显著改善(术前42分,最终随访12分),尤其是运动员相对于非运动员(0.2比16)。目前的方法在43%的病例中获得完全缓解(运动员91%,非运动员16%)。结论:内镜下经腋窝第一肋骨切除术和零位臂丛神经松解术是治疗胸廓出口综合征的有效和安全的方法,尤其是运动员。
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来源期刊
Interactive cardiovascular and thoracic surgery
Interactive cardiovascular and thoracic surgery CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
0.00%
发文量
292
审稿时长
2-4 weeks
期刊介绍: Interactive CardioVascular and Thoracic Surgery (ICVTS) publishes scientific contributions in the field of cardiovascular and thoracic surgery, covering all aspects of surgery of the heart, vessels and the chest. The journal publishes a range of article types including: Best Evidence Topics; Brief Communications; Case Reports; Original Articles; State-of-the-Art; Work in Progress Report.
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