Birinci Yucel, Genc Arzu, Ecevit Mustafa Cenk, Erdag Taner Kemal, Guneri Enis Alpin, Oztura Ibrahim, Evlice Ahmet, Ikiz Ahmet Omer
Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciraltı, Izmir, Turkey.
Otolaryngol Head Neck Surg. 2014 Aug;151(2):253-9. doi: 10.1177/0194599814531021. Epub 2014 Apr 18.
To investigate the role of intraoperative spinal accessory nerve monitoring in predicting postoperative shoulder function in spinal accessory nerve-sparing neck dissections.
Prospective, double-blind clinical trial.
Academic, tertiary care center.
This study was performed on 20 neck sites of 17 consecutive patients who had neck dissections sparing the spinal accessory nerve. Threshold increment ≥0.25 mA and amplitude decrement ≥72% were classified as significant intraoperative neuromonitoring changes while lesser differences were classified as insignificant intraoperative neuromonitoring changes. All patients had intraoperative neuromonitoring recordings when the spinal accessory nerve was first identified and at the end of surgery. Postoperative shoulder function was evaluated neurophysiologically with electromyography and clinically with Constant-Murley Score; daily activity restrictions were evaluated with Activity Restriction Scale.
Clinical assessment of shoulder functions at postoperative first and second months showed statistically significant deteriorations when compared with preoperative values (P < .05). The shoulder function deterioration was statistically significantly less for patients with insignificant intraoperative neuromonitoring changes than patients with significant intraoperative neuromonitoring changes (P < .05). Daily activity restriction deteriorations were present in both groups at first postoperative month (P < .05). While they persisted in the group with significant intraoperative neuromonitoring changes during the second postoperative month (P < .05), there was continuing recovery in the insignificant intraoperative neuromonitoring change group and statistical significance disappeared (P > .05).
Our results support the predictive value of spinal accessory nerve intraoperative neuromonitoring for determining shoulder function deterioration and activity restriction scores.
探讨术中副神经监测在保留副神经的颈部清扫术中预测术后肩部功能的作用。
前瞻性双盲临床试验。
学术性三级医疗中心。
本研究对17例连续接受保留副神经颈部清扫术患者的20个颈部手术部位进行。阈值增量≥0.25 mA和幅度减量≥72%被归类为术中神经监测显著变化，而较小差异则被归类为术中神经监测无显著变化。所有患者在首次识别副神经时及手术结束时均有术中神经监测记录。术后肩部功能通过肌电图进行神经生理学评估，通过Constant-Murley评分进行临床评估；日常活动受限情况通过活动受限量表进行评估。
术后第一个月和第二个月肩部功能的临床评估显示，与术前值相比有统计学显著恶化（P < 0.05）。术中神经监测无显著变化的患者肩部功能恶化程度在统计学上显著低于术中神经监测有显著变化的患者（P < 0.05）。两组在术后第一个月均出现日常活动受限恶化（P < 0.05）。虽然术后第二个月术中神经监测有显著变化的组中仍持续存在（P < 0.05），但术中神经监测无显著变化组持续恢复，统计学差异消失（P > 0.05）。
我们的结果支持术中副神经监测对确定肩部功能恶化和活动受限评分的预测价值。
