Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.
Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain.
J Shoulder Elbow Surg. 2018 Jul;27(7):1275-1282. doi: 10.1016/j.jse.2017.12.030. Epub 2018 Feb 21.
Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure.
Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months.
Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN.
Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.
腋神经和/或肩胛上神经（SSN）的神经术前和术后损伤的发生率高于预期，可能导致功能结果显著下降和反向肩关节置换术（RSA）失败的风险增加。
纳入 2014 年 12 月至 2015 年 12 月期间因肩袖撕裂性关节炎（RCTA）接受 RSA 的患者。本研究重点关注临床（Constant 评分）、影像学以及术后 3 个月和 6 个月的肌电图评估。
20 名患者符合纳入标准，1 名患者失访。术前 15 例患者出现肌电图改变（9 例 SSN 和 15 例腋神经损伤）；均为慢性失用性损伤。所有纳入患者的术前相对 Constant 评分（rCS）平均为 39±9（范围 19-64）。术后 3 个月，两条神经的急性损伤发生率为 31.5%。术后 6 个月，2 例腋神经损伤和 6 例 SSN 损伤保持不变，其余的均有改善或恢复正常。整个队列在 6 个月随访时的术后平均 rCS 为 78±6.5。腋神经和 SSN 术后急性神经损伤的平均术后 rCS 分别为 71±3 和 64±5。
RCTA 中的腋神经和 SSN 损伤的发生率高于预期。这些腋神经病变大多是短暂的，在 6 个月的肌电图检查中几乎完全恢复，对功能的影响很小。然而，SSN 病变的表现不同，功能结果较差，完全恢复的可能性较低。
