Division of Hand Surgery, Department of Orthopedic Surgery (B.C.C., D.M.B., M.F.K., B.T.E., R.J.S., A.T.B., and A.Y.S.), and Department of Neurological Surgery (R.J.S.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for A.Y. Shin:
J Bone Joint Surg Am. 2013 Sep 18;95(18):1667-74. doi: 10.2106/JBJS.L.00238.
The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery.
A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome.
The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus.
Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.
目前的文献表明，肩部手术过程中发生的神经损伤并不常见，而且几乎没有导致任何发病率。本研究的目的是回顾一家机构治疗肩部手术后医源性神经损伤患者的经验。
对 2000 年至 2010 年在臂丛神经专科诊所接受评估的患者记录进行回顾性分析，确定了 26 例因肩部手术引起的医源性神经损伤患者。对记录进行审查，以确定手术程序、就诊时间、体格检查结果、治疗和结果。
平均年龄为 43 岁（范围 17-72 岁），平均转诊前延迟时间为 5.4 个月（范围 1-15 个月）。7 例神经损伤是由治疗不稳定的开放性手术引起的；9 例由关节镜手术引起；4 例由全肩关节置换术引起；6 例由开放性和关节镜联合手术引起。13 例患者的损伤发生在臂丛水平，13 例患者的损伤发生在终末神经支。15 名患者（58%）在观察后未恢复神经功能，需要手术治疗。9 名患者（35%）发生结构性神经损伤（撕裂或缝线嵌顿），包括 8 名终末神经支损伤和 13 名臂丛水平损伤患者。
肩部手术过程中发生的神经损伤可导致严重的发病率，可能需要手术治疗。周围神经水平的损伤比臂丛损伤更有可能通过手术治疗。在评估肩部手术后医源性神经功能缺损患者时，应考虑到高度怀疑、早期转诊和评估。
