Yang Pu, Wang Chen, Zhang Dongfang, Zhang Yi, Yu Tengbo, Qi Chao
Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China.
BMC Musculoskelet Disord. 2021 Feb 18;22(1):202. doi: 10.1186/s12891-021-04075-1.
In the present study, we aimed to determine whether decompression of suprascapular nerve (SSN) at the spinoglenoid notch could lead to a better functional outcome for the patients who underwent repairment of rotator cuff due to posterosupeior massive rotator cuff tear (MRCT) and suprascapular neuropathy.
A total of 20 patients with posterosuperior MRCT and suprascapular neuropathy were analyzed in the present work. The preoperative magnetic resonance imaging (MRI) showed rotator cuff tear in supraspinatus and infraspinatus. All patients underwent arthroscopic rotator cuff repair. Patients were divided into two groups (group A: non-releasing, group B: releasing) according to whether the SSN at the spinoglenoid notch was decompressed. The modified University of California at Los Angeles shoulder rating scale (UCLA) and visual analog scale (VAS) questionnaire were adopted to assess the function of the affected shoulder preoperatively and 12 months after the operation. Electromyography (EMG) and nerve conduction study (NCS) were used to evaluate the nerve condition. Patients underwent MRI and EMG/NCS at 6 months after operation and last follow-up.
All patients were satisfied with the treatment. MRI showed that it was well-healed in 19 patients at 6 months after the operation. However, the fatty infiltration of supraspinatus and infraspinatus was not reversed. Only one patient in the non-releasing group showed the retear. The retear rate of group A and group B were 30% (3/10) and 20% (2/10) respectively at 12 months after the operation. One patient undergoing SSN decompression complained of discomfort in the infraspinatus area. His follow-up EMG after 6 months showed fibrillation potentials (1+) and positive sharp waves (1+) in the infraspinatus. The other patients' EMG results showed no abnormality. The postoperative UCLA and VAS scores were improved in both groups, and there was no significant difference in the follow-up outcomes between the two groups.
Patients with postersuperior MRCT and suprascapular neuropathy, decompression of suprascapular nerve at spinoglenoid notch didn't lead to a better functional outcome with the repairment of rotator cuff. Arthroscopic rotator cuff repair could reverse the suprascapular neuropathy.
Level III.
在本研究中，我们旨在确定肩胛上切迹处肩胛上神经（SSN）减压是否能使因后上巨大肩袖撕裂（MRCT）和肩胛上神经病变而接受肩袖修复的患者获得更好的功能结果。
本研究共分析了20例后上MRCT和肩胛上神经病变患者。术前磁共振成像（MRI）显示冈上肌和冈下肌存在肩袖撕裂。所有患者均接受关节镜下肩袖修复。根据肩胛上切迹处的SSN是否减压，将患者分为两组（A组：未松解组，B组：松解组）。采用改良的加州大学洛杉矶分校肩评分量表（UCLA）和视觉模拟量表（VAS）问卷评估患侧肩部术前及术后12个月的功能。采用肌电图（EMG）和神经传导研究（NCS）评估神经状况。患者在术后6个月和末次随访时接受MRI及EMG/NCS检查。
所有患者对治疗均满意。MRI显示术后6个月19例患者愈合良好。然而，冈上肌和冈下肌的脂肪浸润未得到逆转。未松解组仅1例患者出现再撕裂。术后12个月，A组和B组的再撕裂率分别为30%（3/10）和20%（2/10）。1例接受SSN减压的患者诉冈下肌区域不适。其术后6个月的随访EMG显示冈下肌有纤颤电位（1+）和正锐波（1+）。其他患者的EMG结果无异常。两组术后UCLA和VAS评分均有改善，两组随访结果无显著差异。
对于后上MRCT和肩胛上神经病变患者，肩胛上切迹处肩胛上神经减压在肩袖修复时并未带来更好的功能结果。关节镜下肩袖修复可逆转肩胛上神经病变。
III级。
