| Objective:Neurogenic thoracic outlet syndrome(NTOS)is a syndrome group caused by the structural and/or positional compression in the area of the thoracic outlet.NTOS has long been regarded as one of the most difficult surgical disease to diagnoses since its complicated symptoms and signs,lack of specific sensitive auxiliary examination,as well as a variety of related diseases of confusion.Diagnostic local blocks,as a diagnostic test of NTOS,has become a good choice of clinical diagnose of NTOS.In this research,we are looking for a more scientific and reliable method of the diagnostic block for NTOS through comparison between cervical transversus process block and scalene muscle block.Methods :We selected 60 patients diagnosed as NTOS at the China-Japan Union Hospital of Jilin University from January 2016 to September 2016.All selected patients matched the screening criterion of thoracic outlet syndrome in our hospital,they all had pain and numbness in different degrees on their necks,shoulders and upper limbs.Patients aged between 36 to 59 and weighed between 50 to 75 kilograms.They had been planned to be treated with conservative treatment.They were randomly divided into two groups(n=30): scalene muscle group(S)and transverse process group(T).Mixed solution contains 2 m L 1% ropivacaine,1m L normal saline and 1m L iodinated contrast media.After the injection,all patients were examined by cervical spinal Xray in 30 minutes.Then we recorded and compared the adverse events and therapeutic effect.Results :There is no difference between the two groups in general status(P>0.05).(1)In the cervical spinal X-ray examination,the anterior and middle scalene muscle are both influenced with no statistical significance between the two groups.The longus capitis muscle are absolutely influenced in T groups but none in S group.(2)Compared with S group(6.6%),the incidence of hoarseness in the T group is gnificantly higher(30%)(P < 0.05).In addition,patients in the T group have a significantly higher incidence of Horner’s syndrome(30% VS 6.6%),sensation of asphyxia(13.3% VS 6.6%)and numbness of neck(40% VS 3.3%)compared with their counterparts in the S group with a statistical significance(P < 0.05).Meanwhile,patients in the T group have a significantly lower incidence of numbness of upper extremity(6.7%)compared with the S group patients(16.7%)with a statistical significance(P < 0.05).(3)The follow-up revealed that there are more effective improvement of symptoms after injection in T group(93.3%)compared with S group(83.3%).While,poor effect ratio in scalene muscle group is higher(16.7%)than the counterpart in transverse process group(6.7%).There is no significant different between the two groups in terms of excellent,fine,fair,poor proportion.Conclusion:1.For the cervical transversus process block,the drug diffusion pathway is complex and the diffuse dose is uncontrollable.Beside the anterior scalene muscle and middle scalene muscle,the drug can also affect cervical plexus,cervical sympathetic trunk,vagus / laryngeal recurrent nerve,phrenic nerve associated with longus capitis muscle and prevertebral fascial.The relief of the symptoms is associated with multiple effects and is unable to reflect the relationship between the tension of the scalene muscles and the neurologic symptoms.2.For the scalene muscle block guided by ultrasonography,the drug could be accurately injected into the anterior scalene muscle and middle scalene muscle and can be quantitatively injected into the predetermined area under the guidance of ultrasound.By adjusting the injection site,the nerve block caused by the local infiltration of the drug can be avoided.The relief of the symptoms is associated with the degree of tension of the anterior and middle scalene muscles.3.The diagnosis of NTOS is more accurate and reliable by the scalene muscle block under the guidance of ultrasound. |
PDF Full Text Request