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Article: Neurogenic thoracic outlet decompression: Rationale for sparing the first rib

TitleNeurogenic thoracic outlet decompression: Rationale for sparing the first rib
Authors
KeywordsRib sparing
Supraclavicular
Thoracic outlet syndrome
Issue Date1995
PublisherLippincott Williams & Wilkins.
Citation
Cardiovascular Surgery, 1995, v. 3 n. 6, p. 617-623 How to Cite?
AbstractA total of 168 primary supraclavicular decompressions were performed on 146 patients with neurogenic thoracic outlet syndrome. This report compares the results of rib resection (supraclavicular anterior and middle scalenectomy and first rib resection) with rib-sparing (supraclavicular anterior and middle scalenectomy alone) operations. All patients with cervical ribs were excluded. In total, 125 rib resections and 43 rib-sparing procedures were performed between 1983 and 1992 by a single surgeon. The patients were otherwise comparable in symptoms and physical signs. During surgery there was a significantly higher proportion of pleural injury associated with rib resection (59%) than with rib-sparing (40%) procedures. The mean hospital stay was also prolonged by 1 day in patients undergoing rib resection (P = 0.005). There was no significant difference in early success between the two groups (83% for rib resection, 91% for rib sparing) and no difference in those resuming employment (52% and 63% respectively). Life-table analysis showed that the two groups have similar long-term results (69% and 76% at 2 years). The only important factor determining clinical outcome in primary supraclavicular thoracic outlet syndrome decompression was the duration of symptoms before operation. Some 83% of patients with symptoms less than 2 years had a successful result compared with only 68% in those with symptoms longer than 2 years (P < 0.005). Spontaneous or post-traumatic neurogenic symptoms responded to operation identically. The theoretical benefit of first rib resection to relieve mechanical compression of the brachial plexus is not evident from this review. Thorough removal of the scalene musculature and other myofascial anomalies, preferably through the supraclavicular approach, leads to less patient morbidity, shortens hospitalization, and is recommended for patients with neurogenic thoracic outlet syndrome requiring operative intervention.
Persistent Identifierhttp://hdl.handle.net/10722/84267
ISSN
2005 Impact Factor: 0.977

 

DC FieldValueLanguage
dc.contributor.authorCheng, SWKen_HK
dc.contributor.authorReilly, LMen_HK
dc.contributor.authorNelken, NAen_HK
dc.contributor.authorEllis, WVen_HK
dc.contributor.authorStoney, RJen_HK
dc.date.accessioned2010-09-06T08:50:56Z-
dc.date.available2010-09-06T08:50:56Z-
dc.date.issued1995en_HK
dc.identifier.citationCardiovascular Surgery, 1995, v. 3 n. 6, p. 617-623en_HK
dc.identifier.issn0967-2109en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84267-
dc.description.abstractA total of 168 primary supraclavicular decompressions were performed on 146 patients with neurogenic thoracic outlet syndrome. This report compares the results of rib resection (supraclavicular anterior and middle scalenectomy and first rib resection) with rib-sparing (supraclavicular anterior and middle scalenectomy alone) operations. All patients with cervical ribs were excluded. In total, 125 rib resections and 43 rib-sparing procedures were performed between 1983 and 1992 by a single surgeon. The patients were otherwise comparable in symptoms and physical signs. During surgery there was a significantly higher proportion of pleural injury associated with rib resection (59%) than with rib-sparing (40%) procedures. The mean hospital stay was also prolonged by 1 day in patients undergoing rib resection (P = 0.005). There was no significant difference in early success between the two groups (83% for rib resection, 91% for rib sparing) and no difference in those resuming employment (52% and 63% respectively). Life-table analysis showed that the two groups have similar long-term results (69% and 76% at 2 years). The only important factor determining clinical outcome in primary supraclavicular thoracic outlet syndrome decompression was the duration of symptoms before operation. Some 83% of patients with symptoms less than 2 years had a successful result compared with only 68% in those with symptoms longer than 2 years (P < 0.005). Spontaneous or post-traumatic neurogenic symptoms responded to operation identically. The theoretical benefit of first rib resection to relieve mechanical compression of the brachial plexus is not evident from this review. Thorough removal of the scalene musculature and other myofascial anomalies, preferably through the supraclavicular approach, leads to less patient morbidity, shortens hospitalization, and is recommended for patients with neurogenic thoracic outlet syndrome requiring operative intervention.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins.en_HK
dc.relation.ispartofCardiovascular Surgeryen_HK
dc.rightsCardiovascular Surgery. Copyright © Lippincott Williams & Wilkins.en_HK
dc.subjectRib sparingen_HK
dc.subjectSupraclavicularen_HK
dc.subjectThoracic outlet syndromeen_HK
dc.titleNeurogenic thoracic outlet decompression: Rationale for sparing the first riben_HK
dc.typeArticleen_HK
dc.identifier.emailCheng, SWK: wkcheng@hkucc.hku.hken_HK
dc.identifier.authorityCheng, SWK=rp00374en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/0967-2109(96)82859-6en_HK
dc.identifier.pmid8745182-
dc.identifier.scopuseid_2-s2.0-0029619801en_HK
dc.identifier.hkuros10654en_HK
dc.identifier.volume3en_HK
dc.identifier.issue6en_HK
dc.identifier.spage617en_HK
dc.identifier.epage623en_HK
dc.identifier.scopusauthoridCheng, SWK=7404684779en_HK
dc.identifier.scopusauthoridReilly, LM=7004463873en_HK
dc.identifier.scopusauthoridNelken, NA=6602839073en_HK
dc.identifier.scopusauthoridEllis, WV=7201950708en_HK
dc.identifier.scopusauthoridStoney, RJ=7006621612en_HK

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