胸廓出口综合征的描述性综述（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Masocatto NO, Da-Matta T, Prozzo TG, Couto WJ, Porfirio G. Thoracic outlet syndrome: a narrative review. Síndrome do desfiladeiro torácico: uma revisão narrativa. Rev Col Bras Cir. 2019;46(5):e20192243. Published 2019 Dec 20. 本次学习由谢珺田副主任医师主讲。

Abstract: Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.

摘要:胸腔出口综合征是一组在胸廓出口部位压迫臂丛和锁骨下血管而产生的症候群。根据压迫的部位不同，症状包括疼痛、感觉异常、皮肤苍白，无力。而诊断共识标准尚未建立，但完善的病史、体格检查和适当的影像学检查有助于诊断。胸廓出口综合征的常规一线治疗是保守治疗，包括物理治疗，生活方式改变，非甾体抗炎药和A型肉毒杆菌毒素或类固醇注射治疗。保守治疗失败的患者可以考虑手术减压。本文旨在综述胸廓出口综合征的流行病学、病因学、相关解剖、临床表现、诊断及治疗。

1. Introduction

Thoracic outlet syndrome (TOS) comprises a group of disorders that result in compres-sion of the neurovasculature exiting the thoracic outlet and was first described in 1956 . TOS classically occurs in three spaces—the scalene triangle, the costoclavicular space, and the subcoracoid space. Structures involved in TOS include the subclavian artery and vein, the axillary artery and vein, and brachial plexus—any or all of which may be compressed, resulting in distinct clinical pictures, which can include pain, paresthesia, pallor, weakness, feelings of fullness, and muscle atrophy .

TOS is usually subclassified into neurogenic TOS (nTOS), venous TOS (vTOS), and arterial TOS (aTOS), depending on the appropriate etiology upon presentation. TOS can be caused by congenital, acquired, or traumatic factors, although some degree of trauma is usually seen in a majority of TOS cases . Diagnosis depends upon both knowledge of the patient’s existing risk factors as well as their clinical presentation and may be confirmed with physical exam maneuvers, radiographic imaging, or vascular studies.

1.介绍

胸廓出口综合征(TOS)包括一组导致胸廓出口神经血管受压的疾病，于1956年首次被描述。TOS通常发生在三个部位：斜角肌三角形、肋锁间隙和锁骨下间隙。TOS涉及的结构包括锁骨下动脉和静脉，腋动脉和静脉，臂丛—其中任何一处或全部被压迫均可导致不同的临床症状，包括疼痛，感觉异常，苍白，无力，肢体胀满，肌肉萎缩。

TOS通常分为神经源性TOS (nTOS)、静脉性TOS (vTOS)和动脉性TOS (aTOS)，取决于产生症状的病因。TOS可以由先天的，后天的，或创伤性因素引起的，尽管，不同程度的创伤是TOS最常见的病因。诊断取决于两方面，患者存在的危险因素及其临床表现，可通过物理检查，放射成像，或血管检查来明确诊断。

Treatment of TOS is a multifactorial process, and therapeutic options vary depending on the presenting subtype. While physical therapy is typically the mainstay in conservative nTOS management, other aspects of nTOS treatment may include lifestyle modification, pain management, and anticoagulation . Injection therapy has also been shown to be temporarily effective in reducing symptomatic TOS, as well as a positive surgical prognostic factor . Surgery is usually indicated in symptomatic nTOS candidates who have failed 4–6 weeks of conservative therapy, as well as the vascular etiologies of TOS . While many TOS treatment options exist, the optimal therapy regimen remains unclear. This review aims to provide physicians a brief summary of both pathogenesis, diagnosis, and treatment of TOS, as well as significant findings in the recent literature. A comprehensive electronic literature search, including PubMed, MEDLINE, and Google Scholar databases (1950–2021), was conducted. Previous articles published in peer-reviewed journals, as well as references cited in relevant articles, were also systematically reviewed. Search terms included “thoracic outlet syndrome” AND “diagnosis” OR “imaging” OR “neurogenic” OR “arterial” OR “venous” OR “conservative therapy” OR “injection” OR “surgery”.

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Hence, it did not need any approval by the Ethics Committee.

TOS的治疗是一个多因素的过程，治疗方法根据不同亚型因人而异。而物理疗法在nTOS的保守治疗中通常是主流，nTOS治疗的其他方面包括生活方式的改变，疼痛管理，抗凝治疗。注射疗法也被证明能够暂时性有效减少症状，且是手术预后的阳性因素。

对于保守治疗4-6周效果不佳，且伴有血管原因的nTOS患者，通常需要手术治疗。尽管存在许多TOS治疗方案，但最佳的治疗方案仍不明确。本文综述了TOS的发病机制、诊断和治疗，以及近期文献中的重要发现。我们进行了全面的电子文献检索，包括PubMed、MEDLINE和谷歌Scholar数据库(1950 - 2021年)。对之前在同行评审期刊上发表的文章以及相关文章中引用的参考文献进行系统综述。搜索词包括胸廓出口综合征和诊断或影像学或神经源性或动脉或静脉或保守治疗或注射或手术。这篇文章是基于以前进行的研究，不包含任何作者对人类或动物进行的研究。因此，它不需要伦理委员会的任何批准。