Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, College of Medicine, Inha University, Incheon, Republic of Korea.
J Shoulder Elbow Surg. 2020 Jun;29(6):1096-1103. doi: 10.1016/j.jse.2019.11.014. Epub 2020 Feb 17.
Neurologic problems after reverse total shoulder arthroplasty (RTSA) have been reported, but there are a lack of studies regarding which nerve(s) are damaged and the outcomes for the patients who had neurologic complications after RTSA. The purpose of this study was to assess the prevalence and outcomes of neurologic deficit after RTSA and to evaluate the correlation between nonanatomic rearrangement of the shoulder joint and neurologic complications after RTSA. We hypothesized that the neurologic deficit was associated with excessive distalization or lateralization of the humerus after RTSA.
RTSA was performed on 182 consecutive shoulders with cuff tear arthropathy. Comparative analysis was performed on 34 shoulders with (group 1) and 148 shoulders without (group 2) neurologic deficit.
The mean follow-up period in the study was 58.5 months (range: 24-124). The mean age was 71.5 ± 7.7 years in group 1 and 73.1 ± 7.2 years in group 2. Neurologic deficit after RTSA was found in 34 shoulders (19%). The mean postoperative acromiohumeral distance was 34.1 ± 11.0 mm in group 1 and 29.4 ± 7.6 mm in group 2 (P = .015). Significant differences in terms of postoperative distalization of the humerus were seen between group 1 (24.5 ± 9.4 mm) and group 2 (20.5 ± 8.3 mm) (P = .009). The most common forms of neurologic deficit after RTSA were axillary nerve (41.2%) and radial nerve (15%) injuries. Thirty shoulders (88%) had neuropraxia, and 4 shoulders (12%) had axonotmesis. By conservative treatment, all patients with neurologic complications achieved complete recovery without any additional surgery; the mean recovery period was 7.4 months (range: 2-38 months).
Neurologic deficit occurred in 19% of patients who underwent RTSA, and it was significantly correlated with humeral distalization after surgery. Axillary nerve was mostly involved, and all patients with neurologic deficit achieved complete recovery without any additional surgery.
已报道过反式全肩关节置换术（RTSA）后出现神经问题，但有关哪些神经受损以及 RTSA 后出现神经并发症患者的结果的研究较少。本研究的目的是评估 RTSA 后神经功能缺损的发生率和结果，并评估肩关节非解剖复位与 RTSA 后神经并发症之间的相关性。我们假设神经功能缺损与 RTSA 后肱骨过度远移或外侧化有关。
对 182 例肩袖撕裂性关节炎患者行 RTSA。对 34 例（组 1）和 148 例（组 2）无神经功能缺损的患者进行比较分析。
研究中平均随访时间为 58.5 个月（范围：24-124）。组 1 的平均年龄为 71.5 ± 7.7 岁，组 2 为 73.1 ± 7.2 岁。RTSA 后发现神经功能缺损 34 例（19%）。组 1 的术后肩峰肱距为 34.1 ± 11.0mm，组 2 为 29.4 ± 7.6mm（P =.015）。组 1（24.5 ± 9.4mm）与组 2（20.5 ± 8.3mm）之间存在显著的术后肱骨远移差异（P =.009）。RTSA 后最常见的神经功能缺损形式为腋神经（41.2%）和桡神经（15%）损伤。30 例（88%）为神经失用，4 例（12%）为轴索断裂。经保守治疗，所有神经并发症患者均无需进一步手术即完全恢复，平均恢复时间为 7.4 个月（范围：2-38 个月）。
RTSA 后 19%的患者出现神经功能缺损，与术后肱骨远移明显相关。最常受累的是腋神经，所有神经功能缺损患者均无需进一步手术即可完全恢复。
