Parisien Robert L, Yi Paul H, Hou Laura, Li Xinning, Jawa Andrew
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA.
Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2016 Jul;25(7):1122-7. doi: 10.1016/j.jse.2016.02.016.
This study compared the incidence and pattern of potential nerve injuries between reverse shoulder (RSA) and total shoulder arthroplasty (TSA) using intraoperative neuromonitoring. Our hypothesis was that RSA has a greater risk of nerve injury than TSA due to arm lengthening.
We reviewed 36 consecutive patients who underwent RSA (n = 12) or TSA (n = 24) with intraoperative neuromonitoring. The number of nerve alerts was recorded for each stage of surgery. Neurologic function was assessed preoperatively and postoperatively at routine follow-up visits. Predictive factors for increased intraoperative nerve alerts and clinically detectable neurologic deficits were determined.
There were nearly 5 times as many postreduction nerve alerts per patient in the RSA cohort compared with the TSA cohort (2.17 vs. 0.46). There were 17 unresolved nerve alerts postoperatively, with only 2 clinically detectable nerve injuries, which fully resolved by 6 months postoperatively. A preoperative decrease in active forward flexion and the diagnosis of rotator cuff arthropathy were independent predictors of intraoperative nerve alerts.
RSA has a higher incidence of intraoperative nerve alerts than TSA during the postreduction stage due to arm lengthening. Decreased preoperative active forward flexion and the diagnosis of rotator cuff arthropathy are predictors of more nerve alerts. The clinical utility of routine intraoperative nerve monitoring remains in question given the high level of nerve alerts and lack of persistent postoperative neurologic deficits.
本研究使用术中神经监测比较了反肩关节置换术（RSA）和全肩关节置换术（TSA）中潜在神经损伤的发生率和模式。我们的假设是，由于手臂延长，RSA比TSA有更高的神经损伤风险。
我们回顾了36例接受RSA（n = 12）或TSA（n = 24）并进行术中神经监测的连续患者。记录手术各阶段的神经警报数量。在术前和术后常规随访时评估神经功能。确定术中神经警报增加和临床上可检测到的神经功能缺损的预测因素。
与TSA队列相比，RSA队列中每位患者复位后神经警报的数量几乎是其5倍（2.17比0.46）。术后有17例未解决的神经警报，只有2例临床上可检测到的神经损伤，术后6个月完全恢复。术前主动前屈减少和肩袖关节病的诊断是术中神经警报的独立预测因素。
由于手臂延长，RSA在复位后阶段术中神经警报的发生率高于TSA。术前主动前屈减少和肩袖关节病的诊断是更多神经警报的预测因素。鉴于神经警报水平高且术后缺乏持续性神经功能缺损，术中常规神经监测的临床实用性仍存在疑问。
