McGarvey A C, Hoffman G R, Osmotherly P G, Chiarelli P E
Physiotherapy Department,Calvary Mater Newcastle Hospital,NSW,Australia.
School of Medicine and Public Health,Faculty of Health,University of Newcastle,Callaghan,Australia.
J Laryngol Otol. 2014 Sep;128(9):746-51. doi: 10.1017/S0022215113002934. Epub 2014 Aug 29.
To investigate evidence that intra-operative nerve monitoring of the spinal accessory nerve affects the prevalence of post-operative shoulder morbidity and predicts functional outcome.
A search of the Medline, Scopus and Cochrane databases from 1995 to October 2012 was undertaken, using the search terms 'monitoring, intra-operative' and 'accessory nerve'. Articles were included if they pertained to intra-operative accessory nerve monitoring undertaken during neck dissection surgery and included a functional shoulder outcome measure. Further relevant articles were obtained by screening the reference lists of retrieved articles.
Only three articles met the inclusion criteria of the review. Two of these included studies suggesting that intra-operative nerve monitoring shows greater specificity than sensitivity in predicting post-operative shoulder dysfunction. Only one study, with a small sample size, assessed intra-operative nerve monitoring in neck dissection patients.
It is unclear whether intra-operative nerve monitoring is a useful tool for reducing the prevalence of accessory nerve injury and predicting post-operative functional shoulder outcome in patients undergoing neck dissection. Larger, randomised studies are required to determine whether such monitoring is a valuable surgical adjunct.
探讨术中对副神经进行神经监测是否会影响术后肩部发病率，并预测功能结局。
检索1995年至2012年10月的Medline、Scopus和Cochrane数据库，使用检索词“术中监测”和“副神经”。如果文章涉及颈部解剖手术中进行的术中副神经监测，并包括功能性肩部结局测量，则纳入这些文章。通过筛选检索到的文章的参考文献列表获得更多相关文章。
只有三篇文章符合该综述的纳入标准。其中两篇研究表明，术中神经监测在预测术后肩部功能障碍方面显示出更高的特异性而非敏感性。只有一项样本量较小的研究评估了颈部解剖患者的术中神经监测。
目前尚不清楚术中神经监测是否是一种有用的工具，可用于降低接受颈部解剖的患者的副神经损伤发生率，并预测术后肩部功能结局。需要进行更大规模的随机研究来确定这种监测是否是一种有价值的手术辅助手段。
