臨床整形外科59巻2号

2024年02月発行

特集 ここまで来た! 胸郭出口症候群の診断と治療

解剖研究と文献から考える胸郭出口症候群の安全な治療

著者： 佐竹寛史¹ 仁藤敏哉¹

所属機関： ¹山形大学医学部整形外科学講座

ページ範囲：P.137 - P.142

胸郭出口症候群を発症する部位は斜角筋間，肋鎖間隙，および小胸筋・烏口突起部であると言われており，当科では斜角筋間や肋鎖間隙の狭窄症例に手術を行ってきた．解剖研究や内視鏡補助下手術により，前方から鎖骨下静脈，前斜角筋，鎖骨下動脈，腕神経叢，および中斜角筋が走行していることがわかった．前斜角筋は第1肋骨上方に停止しているとされるが，ほとんどは第1肋骨後方に停止しており，中斜角筋は上方に停止していた．

参考文献

1) Coote H. Exostosis of the left transverse process of the seventh cervical vertebra, surrounded by blood vessels and nerves:successful removal. Lancet 1861;1:360-1.

2) Morley J. Brachial pressure neuritis due to a normal first thoracic rib:its diagnosis and treatment by excision of rib. Clin J 1913;22:461-4.

3) Adson AW, Coffey JR. Cervical rib:a method of anterior approach for relief of symptoms by division of the scalenus anticus. Ann Surg 1927;85(6):839-57.

4) Rogers L. Upper-limb pain due to lesions of the thoracic outlet;the scalenus syndrome, cervical rib, and costoclavicular compression. Br Med J 1949;2(4634):956-8.

5) Seroyer ST, Nho SJ, Bach BR Jr, et al. Shoulder pain in the overhead throwing athlete. Sports Health 2009;1(2):108-20.

6) Panther EJ, Reintgen CD, Cueto RJ, et al. Thoracic outlet syndrome:a review. J Shoulder Elbow Surg 2022;31(11):e545-61. doi:10.1016/j.jse.2022.06.026

7) Sakamoto Y. Spatial relationships between the morphologies and innervations of the scalene and anterior vertebral muscles. Ann Anat 2012;194(4):381-8.

8) Kirgis HD, Reed AF. Significant anatomic relations in the syndrome of the scalene muscles. Ann Surg 1948;127(6):1182-201.

9) Nichols HM. Anatomic structures of the thoracic outlet. Clin Orthop Relat Res 1967;51:17-25.

10) Dahlstrom KA, Olinger AB. Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome:a study of 60 cadavers. J Manipulative Physiol Ther 2012;35(5):396-401.

11) Furushima K, Funakoshi T, Kusano H, et al. Endoscopic-assisted transaxillary approach for first rib resection in thoracic outlet syndrome. Arthrosc Sports Med Rehabil 2021;3(1):e155-62. doi:10.1016/j.asmr.2020.08.019

12) Satake H, Honma R, Nito T, et al. Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome. Interact Cardiovasc Thorac Surg 2022;35(4):ivac239. doi:10.1093/icvts/ivac239

13) Kaplan T, Cömert A, Güner MA, et al. Measurement of interscalene space volume in diagnosis of thoracic outlet syndrome:a cadaver study. Turk J Med Sci 2021;51(4):1849-56.

14) Duarte FH, Zerati AE, Gornati VC, et al. Normal costoclavicular distance as a standard in the radiological evaluation of thoracic outlet syndrome in the costoclavicular space. Ann Vasc Surg 2021;72:138-46.