Patterson Brendan M, Reed Evelyn R, Hill Elspeth, Buckwalter V Joseph A, Bozoghlian Maria F, Mackinnon Susan E
University of Iowa, Iowa City, USA.
The University of Utah, Salt Lake City, USA.
Hand (N Y). 2024 May;19(3):352-360. doi: 10.1177/15589447221142886. Epub 2022 Dec 23.
Nerve injuries remain a challenging complication after shoulder surgery. While most resolve spontaneously, some require surgical intervention. This study describes the characteristics of patients sustaining nerve injuries following shoulder surgery, evaluates referral patterns to nerve surgeons, and characterizes nerve surgeries performed and their outcomes. Increased awareness of these injuries allows patients and providers to be better informed regarding the appropriate management when these complications occur.
A retrospective review of referrals with nerve injuries following shoulder surgery between 2007 and 2015 was performed. The final analysis included 65 patients. Data reviewed included demographics, procedure and anesthesia type, and diagnosis of nerve injury. Time to referral to nerve surgeon and proportional changes in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores were determined. Outcomes were categorized as failed, partially successful, and successful based on final follow-up.
Patients were referred following arthroscopic shoulder surgeries (35.4%), shoulder arthroplasties (24.6%), open shoulder procedures (21.5%), and combined open and arthroscopic procedures (18.5%). The mean time to referral was 7.6 months. Nerve injuries involved brachial plexus (33) and individual and multiple peripheral nerve branches (23 and 7, respectively). Twenty-five (38%) nerve injuries demonstrated spontaneous recovery. Thirty-five patients underwent surgical intervention, of which 27 were successful, 3 were partially successful, and 3 failed.
This is the largest series of patients with iatrogenic nerve injury following shoulder surgeries to date. Our data demonstrate a lack of timely referral to nerve surgeons, especially after arthroscopy. There continues to be a variable injury pattern even among similar surgeries. Despite this, timely surgical intervention, when indicated, can lead to favorable outcomes.
神经损伤仍是肩部手术后具有挑战性的并发症。虽然大多数损伤可自行恢复，但有些需要手术干预。本研究描述了肩部手术后发生神经损伤的患者特征，评估了转诊至神经外科医生的模式，并对所进行的神经手术及其结果进行了特征描述。提高对这些损伤的认识有助于患者和医疗服务提供者在这些并发症发生时更好地了解适当的处理方法。
对2007年至2015年间肩部手术后发生神经损伤的转诊病例进行回顾性研究。最终分析纳入65例患者。所审查的数据包括人口统计学资料、手术和麻醉类型以及神经损伤的诊断。确定了转诊至神经外科医生的时间以及手臂、肩部和手部功能障碍（DASH）评分的比例变化。根据最终随访结果将结局分为失败、部分成功和成功。
患者在关节镜下肩部手术（35.4%）、肩关节置换术（24.6%）、开放性肩部手术（21.5%）以及开放性和关节镜联合手术（18.5%）后被转诊。平均转诊时间为7.6个月。神经损伤涉及臂丛神经（33例）以及单个和多个周围神经分支（分别为23例和7例）。25例（38%）神经损伤显示自发恢复。35例患者接受了手术干预，其中27例成功，3例部分成功，3例失败。
这是迄今为止关于肩部手术后医源性神经损伤患者的最大系列研究。我们的数据表明，尤其是在关节镜检查后，缺乏及时转诊至神经外科医生的情况。即使在类似手术中，损伤模式仍存在差异。尽管如此，在有指征时及时进行手术干预可带来良好的结局。
