Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.
Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.
Arthroscopy. 2020 Jun;36(6):1555-1564. doi: 10.1016/j.arthro.2020.02.016. Epub 2020 Feb 26.
To investigate the incidence of axillary nerve palsy after arthroscopic shoulder stabilization and to measure the distance between the nerve and capsule in shoulders with a capsular lesion.
This retrospective study included 2,027 shoulders (1,909 patients; 1,433 male and 476 female patients; mean age, 32 years [age range, 13-81 years]) subjected to arthroscopic soft-tissue stabilization for recurrent shoulder instability from 2005 to 2017. The exclusion criteria were bone grafting or transfer and preoperative axillary nerve symptoms. We retrospectively reviewed patient records and investigated the incidence and clinical features of axillary nerve palsy. We measured the closest distance between the axillary nerve and capsule on preoperative magnetic resonance images.
Postoperative axillary nerve palsy occurred in 4 shoulders (0.2% of all arthroscopic stabilizations). Capsular repair was performed in 2 shoulders (1.2% of 160 capsular repairs); humeral avulsion of the glenohumeral ligament (HAGL) repair, 1 shoulder (2% of 47 HAGL repairs); and isolated Bankart repair, 1 shoulder (0.05% of 1,941 Bankart repairs). The closest distance between the nerve and capsule was 3.4 ± 3.2 mm in shoulders with capsular or HAGL lesions and less than 1 mm in the 3 shoulders with palsy. The common symptoms in axillary nerve palsy cases were shoulder discomfort, delayed recovery of range of motion, and deltoid weakness and atrophy. A definitive diagnosis was made with electromyography in all cases. Nerve injury by a suture was confirmed during revision surgery in 3 shoulders subjected to capsular or HAGL repair during the initial operation. The palsy was transient and fully recovered in 1 shoulder with isolated Bankart repair.
The incidence of axillary nerve palsy after arthroscopic soft-tissue shoulder stabilization was low but higher in shoulders subjected to capsular or HAGL repair. We should always consider the possibility of axillary nerve palsy in shoulders that require capsular or HAGL repair.
Level IV, therapeutic case series.
研究关节镜下肩关节稳定术后腋神经麻痹的发生率，并测量伴有囊状病变的肩关节中神经与囊之间的距离。
本回顾性研究纳入了 2005 年至 2017 年间因复发性肩关节不稳定而行关节镜下软组织稳定术的 2027 例肩关节（1909 例患者；1433 例男性，476 例女性；平均年龄 32 岁[年龄范围 13-81 岁]）。排除标准为植骨或转移以及术前腋神经症状。我们回顾性地查阅了患者的病历资料，并调查了腋神经麻痹的发生率和临床特征。我们测量了术前磁共振成像上腋神经与囊之间的最短距离。
术后发生腋神经麻痹 4 例（所有关节镜稳定术中的 0.2%）。2 例（160 例囊状修复中的 1.2%）行囊状修复；1 例（47 例 HAGL 修复中的 2%）行肩盂肱韧带撕裂（HAGL）撕裂修复；1 例（1941 例 Bankart 修复中的 0.05%）行单纯 Bankart 修复。伴有囊状或 HAGL 病变的肩关节神经与囊之间的最短距离为 3.4±3.2mm，而 3 例发生麻痹的肩关节小于 1mm。腋神经麻痹病例的常见症状为肩部不适、运动范围恢复延迟、三角肌无力和萎缩。所有病例均通过肌电图确诊。在 3 例初始手术中进行囊状或 HAGL 修复的患者中，在revision 手术中证实了缝线对神经的损伤。孤立 Bankart 修复的 1 例患者的麻痹是暂时的，完全恢复。
关节镜下软组织肩关节稳定术后腋神经麻痹的发生率较低，但在进行囊状或 HAGL 修复的肩关节中发生率较高。在需要囊状或 HAGL 修复的肩关节中，我们应始终考虑腋神经麻痹的可能性。
IV 级，治疗性病例系列。
