抄録
We reviewed 48 patients (24 men and 24 women) who underwent 53 primary operations for thoracic outlet syndrome (TOS) . Age at the time of surgery ranged from 15 to 60 years (average 28.0 years) . We performed 43 transaxillary first-rib resections, 8 scalenotomies via a supraclavicular approach, and 2 combined operations (transaxillary plus supraclavicular approach) . In 56.6% of the patients, single or multiple anatomical abnormalities were noted. Twelve patients (25%) had a history of neck trauma. The average follow-up period was 10 years (range 6 to 17 years) . Good or excellent results were obtained in 74.4% of the transaxillary first-rib resections, 50% of the scalenotomies, and 100% of the combined operations. As for complications, no permanent nerve injury occurred. We conclude that transaxillary first-rib resection is a safe and effective treatment for TOS. This study confirmed that the success rate of transaxillary first-rib resection did not decrease during a long-term follow-up period. However, scalenotomy was less effective for TOS. Anatomical abnormalities, preoperative neurological deficits, and gender had no effect on the results. A history of trauma did not have a negative effect. In a majority of the patients with fair or poor results, not only compression but also stretching of the brachial plexus were suspected as the underlying pathophysiology. Excluding such patients in final assessment would yield better long-term results thoracic outlet decompression.
