Service de chirurgie du membre supérieur, centre de chirurgie orthopédique et de la main, hôpitaux universitaires de Strasbourg, 10, avenue Achille-Baumann, 67403 Illkirch cedex, France.
Orthop Traumatol Surg Res. 2013 Oct;99(6 Suppl):S329-35. doi: 10.1016/j.otsr.2013.07.010. Epub 2013 Aug 20.
Scapular winging secondary to serratus anterior muscle palsy is a rare pathology. It is usually due to a lesion in the thoracic part of the long thoracic nerve following violent upper-limb stretching with compression on the nerve by the anterior branch of thoracodorsal artery at the "crow's foot landmark" where the artery crosses in front of the nerve. Scapular winging causes upper-limb pain, fatigability or impotence. Diagnosis is clinical and management initially conservative. When functional treatment by physiotherapy fails to bring recovery within 6 months and electromyography (EMG) shows increased distal latencies, neurolysis may be suggested. Muscle transfer and scapula-thoracic arthrodesis are considered as palliative treatments. We report a single-surgeon experience of nine open neurolyses of the thoracic part of the long thoracic nerve in eight patients. At 6 months' follow-up, no patients showed continuing signs of winged scapula. Control EMG showed significant reduction in distal latency; Constant scores showed improvement, and VAS-assessed pain was considerably reduced. Neurolysis would thus seem to be the first-line surgical attitude of choice in case of compression confirmed on EMG. The present results would need to be confirmed in larger studies with longer follow-up, but this is made difficult by the rarity of this pathology.
III.
前锯肌瘫痪导致的肩胛骨翼状突出是一种罕见的疾病。它通常是由于胸长神经的胸段受损引起的，这种损伤是在剧烈的上肢伸展时发生的，在前锯肌分支和胸背动脉在“乌鸦脚”处压迫神经，此处动脉在前臂穿过神经。肩胛骨翼状突出会导致上肢疼痛、易疲劳或无力。诊断是基于临床表现，最初采用保守治疗。如果理疗 6 个月后功能治疗没有恢复，并且肌电图（EMG）显示远端潜伏期增加，则可能建议进行神经松解术。肌肉转移和肩胛骨-胸廓关节融合术被认为是姑息性治疗。我们报告了一位外科医生对 8 名患者的 9 例胸长神经胸段开放性神经松解术的经验。在 6 个月的随访中，没有患者出现持续的肩胛骨翼状突出迹象。对照肌电图显示远端潜伏期明显降低；Constant 评分有所改善，VAS 评估的疼痛明显减轻。因此，在 EMG 证实存在压迫的情况下，神经松解似乎是首选的一线手术方法。需要在更长时间随访的更大研究中证实这些结果，但由于这种疾病罕见，这很难做到。
III。
