Vastamäki M, Vastamäki H, Pikkarainen V, Ristolainen L
ORTON Research Institute, ORTON Foundation, Helsinki, Finland.
Scand J Surg. 2018 Dec;107(4):356-359. doi: 10.1177/1457496918766716. Epub 2018 Apr 9.
: The course of isolated serratus palsy is difficult to predict, especially if, in initial electromyographic examination, long thoracic nerve function is totally absent. How initial electromyography correlates with long-term outcome of isolated serratus palsy is unknown. We evaluated initial electromyographic examinations of isolated serratus palsy patients and compared these to their long-term outcome. We hypothesized that long-term outcome after electromyographic examination-verified partial nerve injuries is better than that seen in cases of total nerve injuries.
: We retrospectively reviewed 90 patients with isolated serratus palsy and with initial electromyographic examination treated by brace or observation only, by determining pain, range of motion, and degree of scapular winging after a mean follow-up of 17.8 years.
: Initial electromyographic examination showed total denervation in 21 cases (22%), partial severe denervation in 30 (33%), and partial moderate or slight denervation in 39 (44%). Recovery of serratus muscle function occurred in 17/21 cases (81%) of total denervation and in 47/69 cases (68%) of partial denervation, p = 0.247. Mean flexion in total denervation recovered to 152° and in partial to 157°, p = 0.301, and abduction to 173° and 174°, p = 0.970. In total denervation, 60% of patients were pain-free, in partial, 48%, p = 0.338. The duration of scapular winging among those 42 who subjectively recovered averaged 15.1 months, in 13 patients with total denervation 15.9 months, and in 29 patients with partial denervation 14.7 months (p = 0.599).
: Initial electromyographic examination does not predict clinical outcomes: ROM, pain, scapular winging and strength, but partial denervation may negatively predict subjective outcome.
孤立性锯肌麻痹的病程难以预测，尤其是在初次肌电图检查时，胸长神经功能完全缺失的情况下。初次肌电图检查与孤立性锯肌麻痹的长期预后之间的关系尚不清楚。我们评估了孤立性锯肌麻痹患者的初次肌电图检查结果，并将其与长期预后进行比较。我们假设，经肌电图检查证实为部分神经损伤的患者的长期预后要优于完全神经损伤的患者。
我们回顾性分析了90例孤立性锯肌麻痹患者，这些患者仅接受了支具治疗或观察，并进行了初次肌电图检查，通过在平均17.8年的随访后确定疼痛、活动范围和肩胛翼状畸形的程度。
初次肌电图检查显示，21例（22%）为完全失神经支配，30例（33%）为部分严重失神经支配，39例（44%）为部分中度或轻度失神经支配。完全失神经支配的21例患者中有17例（81%）锯肌功能恢复，部分失神经支配的69例患者中有47例（68%）恢复，p = 0.247。完全失神经支配患者的平均屈曲恢复到152°，部分失神经支配患者恢复到157°，p = 0.301；外展分别恢复到173°和174°，p = 0.970。完全失神经支配的患者中，60%无疼痛，部分失神经支配的患者中，48%无疼痛，p = 0.338。在主观上恢复的42例患者中，肩胛翼状畸形的持续时间平均为15.1个月，13例完全失神经支配的患者为15.9个月，29例部分失神经支配的患者为14.7个月（p = 0.599）。
初次肌电图检查无法预测临床结局：活动范围、疼痛、肩胛翼状畸形和力量，但部分失神经支配可能对主观结局产生负面预测。
