Zusammenfassung
Viele verschiedene Operationsverfahren sind zur Behandlung des Thoracic-outlet-Syndroms
(TOS) entwickelt worden, bei dem neurovaskuläre Strukturen am „thoracic outlet“ komprimiert
werden. Die transaxilläre Resektion der ersten Rippe sowie die transzervikale vordere
und mittlere Skalenektomie sind die häufigsten Standardverfahren. Einige Chirurgen
begannen Anfang der 80er-Jahre, beide Verfahren zu kombinieren (zuerst die Skalenektomie,
dann die transaxilläre Rippenresektion). Wir haben erprobt, dass diese Kombination
in umgekehrter Reihenfolge (zuerst die Resektion der ersten Rippe und anschließend
sofortige vordere und mittlere Skalenektomie) zu einer vollständigen Entlastung des
„thoracic outlet“ führt, die Symptome besser lindert und die Rezidivrate senkt.
Abstract
Many different procedures have been developed to treat thoracic outlet compression
syndrome (TOCS), a condition in which neurovascular structures in the thoracic outlet
region are compressed. Currently, transaxillary first rib resection and transcervical
anterior and middle scalenectomy are the most popular and standard procedures. In
the early 1980s, some surgeons started to perform both procedures, starting with the
scalenectomy and following with a transaxillary first rib resection. We have found
that performing these procedures in the reverse order, starting with the first rib
resection and following immediately with a transcervical anterior and middle scalenectomy
accomplishes total decompression of the thoracic outlet area with much better improvement
of symptoms and much lower recurrence rate.
Schlüsselwörter
TOS - Resektion erste Rippe - Skalenektomie
Key words
TOS - first rib resection - scalenectomy
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1 Reprinted with permission and slight modifications from Atasoy E: Combined surgical
treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical
scalenectomy. Hand Clin 2004; 20: 71 - 82
M.D. Erdoğan Atasoy
Kleinert, Kurtz and Associates Hand Care Center
225 Abraham Flexner Way, Suite 700
Louisville, KY 40202
USA
eMail: bstewart@kleinertkurtz.com
