【摘要】 患者女，26岁，因发现右手大鱼际肌萎缩1周就诊。颈椎及头颅MRI未见明显异常。肌电图检查示大鱼际肌复合肌肉动作电位波幅降低，提示正中神经返支重度受损。颈椎X线正侧位片示双侧C7横突过长。臂丛神经彩色多普勒超声及MRI提示C8、T1神经根轻度水肿、走行迂曲，臂丛神经前方可见异常小斜角肌，右侧锁骨下肌较左侧肥厚。最终诊断为神经型胸廓出口综合征，行经锁骨上下联合入路胸廓出口减压术，包括前斜角肌、小斜角肌及异常束带切除，并行锁骨下肌切除术。术后患者恢复良好出院。鉴于该病临床表现易与腕管综合征、正中神经返支卡压等混淆，本病例提示对于大鱼际肌萎缩患者需注意鉴别神经型胸廓出口综合征可能。更多还原

【Abstract】 A 26-year-old female patient presented with a 1-week history of right thenar muscle atrophy. Cervical spine and brain MRI showed no obvious abnormalities. Electromyography revealed a reduced amplitude of compound muscle action potential in the thenar muscle, indicating severe impairment of the recurrent branch of the median nerve. Anteroposterior and lateral cervical X-rays showed bilateral elongated C7 transverse processes. Color Doppler ultrasound and MRI of the brachial plexus indicated mild edema and tortuous course of the C8 and T1 nerve roots, an abnormal scalenus minimus muscle anterior to the brachial plexus, and hypertrophy of the right subclavius muscle compared to the left. A final diagnosis of neurogenic thoracic outlet syndrome was made, and the patient underwent combined supraclavicular and infraclavicular thoracic outlet decompression,including resection of the anterior scalene muscle, scalenus minimus muscle, abnormal fibrous bands, and subclavius muscle. The patient recovered well and was discharged. Given that the clinical manifestations of this condition can easily be confused with carpal tunnel syndrome, median nerve recurrent branch entrapment, and other disorders, this case highlights the need to consider neurogenic thoracic outlet syndrome in the differential diagnosis of patients with thenar muscle atrophy.更多还原