Department of Orthopedics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Department of Orthopedics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
J Shoulder Elbow Surg. 2019 Aug;28(8):1617-1625. doi: 10.1016/j.jse.2019.01.007. Epub 2019 May 4.
The aim of this study was to evaluate the risk of nerve injury with neuromonitoring during reverse total shoulder arthroplasty.
This study included 15 shoulders of 15 patients (11 females and 4 males) who underwent reverse total shoulder arthroplasty. The mean age was 74.8 ± 4.4 years. Nine shoulders had cuff tear arthropathy, 4 had massive rotator cuff tears, 2 had osteoarthritis, and 1 had rheumatoid arthritis. The somatosensory evoked potentials of the median nerve, transcranial motor evoked potentials, and free-electromyograms from 6 upper-extremity muscles were measured intraoperatively. We defined a nerve alert as 50% amplitude attenuation or 10% latency prolongation of the somatosensory evoked potentials and transcranial motor evoked potentials and sustained neurotonic discharge on free-electromyogram.
Thirty-one alerts were recorded in 11 patients. The axillary nerve was associated with 17 alerts. Eleven alerts occurred during the glenoid procedure and 5 alerts occurred during the humeral procedure. One patient who did not recover from the alert of the axillary nerve had clinically incomplete paralysis of the deltoid muscle.
The present findings suggest that the axillary nerve was the nerve most frequently exposed to the risk of injury, especially during glenoid and humeral implantation.
本研究旨在评估反向全肩关节置换术中神经监测时发生神经损伤的风险。
本研究共纳入 15 例 15 肩（11 例女性，4 例男性）患者，均行反向全肩关节置换术。平均年龄为 74.8±4.4 岁。9 例为肩袖撕裂性关节炎，4 例为巨大肩袖撕裂，2 例为骨关节炎，1 例为类风湿关节炎。术中测量正中神经体感诱发电位、经颅运动诱发电位和 6 块上肢肌肉的自由肌电图。我们将体感诱发电位和经颅运动诱发电位的振幅衰减 50%或潜伏期延长 10%，以及自由肌电图上持续的神经紧张性放电定义为神经警报。
11 例患者共记录到 31 次警报。腋神经与 17 次警报相关。11 次警报发生在肩胛盂处理过程中，5 次警报发生在肱骨处理过程中。1 例腋神经警报未恢复的患者三角肌存在临床不完全瘫痪。
本研究结果提示，腋神经最容易受到损伤风险的影响，尤其是在肩胛盂和肱骨植入过程中。
