Costouros John G, Porramatikul Mason, Lie Denny T, Warner Jon J P
Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Arthroscopy. 2007 Nov;23(11):1152-61. doi: 10.1016/j.arthro.2007.06.014.
The purpose of this study was to study the prevalence of suprascapular neuropathy (SSN) in the setting of massive rotator cuff tears and to determine if arthroscopic rotator cuff repair, even if partial, was associated with reversal of SSN and clinical improvement in pain and function.
Over a 13-month period, 26 of 216 patients with rotator cuff tears treated operatively were identified to have massive tears associated with retraction and moderate to severe fatty infiltration of the supraspinatus and infraspinatus muscles. All patients had pain and marked weakness in abduction and external rotation which did not improve with conservative treatment. Electrodiagnostic electromyographic/nerve conduction velocity (EMG/NCV) evaluation, as well as pre- and postoperative questionnaire and physical examination, were performed. An arthroscopic repair, either partial or complete, was performed on patients identified to have a massive rotator cuff tear in association with SSN.
Fourteen of 26 patients with massive rotator cuff tears (54%) were identified to have a peripheral nerve injury. Seven of these 26 (38%) had isolated suprascapular nerve injury, 4 had axillary nerve injury, 2 had an associated upper trunk brachial plexus injury, and 1 had a cervical radiculopathy. All 7 patients with isolated suprascapular injury underwent arthroscopic treatment, 1 of which was not technically reparable at the time of surgery. In the 6 patients who underwent either partial or complete arthroscopic repair, follow-up EMG/NCV after 6 months demonstrated partial or full recovery of the suprascapular nerve palsy that correlated with complete pain relief and marked improvement in function.
SSN is found in a significant proportion of patients with massive rotator cuff tears, and is associated with pain and dysfunction. Arthroscopic rotator cuff repair can result in reversal of SSN, which may correlate with substantial improvement in pain and function.
Level IV, case series.
本研究旨在探讨巨大肩袖撕裂患者中肩胛上神经病变（SSN）的患病率，并确定关节镜下肩袖修复术（即使是部分修复）是否与SSN的逆转以及疼痛和功能的临床改善相关。
在13个月的时间里，对216例接受手术治疗的肩袖撕裂患者进行了研究，其中26例被确定为存在与上、下冈上肌和冈下肌回缩及中度至重度脂肪浸润相关的巨大撕裂。所有患者均有疼痛，外展和外旋明显无力，保守治疗无效。进行了电诊断肌电图/神经传导速度（EMG/NCV）评估，以及术前和术后问卷调查及体格检查。对被确定为存在与SSN相关的巨大肩袖撕裂的患者进行了关节镜修复，修复方式为部分或完全修复。
26例巨大肩袖撕裂患者中有14例（54%）被确定存在周围神经损伤。其中26例中有7例（38%）为孤立性肩胛上神经损伤，4例为腋神经损伤，2例为合并上干臂丛神经损伤，1例为颈椎病。所有7例孤立性肩胛上神经损伤患者均接受了关节镜治疗，其中1例在手术时无法进行技术修复。在6例接受部分或完全关节镜修复的患者中，6个月后的随访EMG/NCV显示肩胛上神经麻痹部分或完全恢复，这与疼痛完全缓解和功能显著改善相关。
在相当比例的巨大肩袖撕裂患者中发现了SSN，且与疼痛和功能障碍相关。关节镜下肩袖修复可导致SSN逆转，这可能与疼痛和功能的显著改善相关。
IV级，病例系列。
