Duncan M A, Lotze M T, Gerber L H, Rosenberg S A
Phys Ther. 1983 Aug;63(8):1243-7. doi: 10.1093/ptj/63.8.1243.
The purposes of this study were to determine the occurrence of serratus anterior muscle weakness after axillary node dissection, to monitor the recovery of serratus anterior muscle strength, and to compare shoulder range of motion in palsied and nonpalsied groups. Thirty-six patients were studied who had 40 axillary node dissections for breast carcinoma or malignant melanoma. Range of motion and manual muscle tests were done preoperatively and at specific postoperative intervals by two observers. To regain range of motion, all subjects were treated daily while hospitalized and as needed when outpatients. Twelve of the 40 dissections (30%) resulted in serratus anterior muscle palsy after surgery. Strength was normal in all the palsied shoulders by the sixth month after surgery. Both the palsied and nonpalsied groups had comparable range of motion at each assessment. The mechanism of long thoracic nerve injury and the clinical significance of serratus anterior muscle palsy are discussed as well as the rationale for early detection and proper physical therapy management. This study suggests that serratus anterior muscle palsy is a frequent but reversible event after axillary node dissection.
本研究的目的是确定腋窝淋巴结清扫术后前锯肌无力的发生率，监测前锯肌力量的恢复情况，并比较麻痹组和非麻痹组的肩关节活动范围。对36例因乳腺癌或恶性黑色素瘤而行40次腋窝淋巴结清扫术的患者进行了研究。术前及术后特定时间间隔由两名观察者进行活动范围和手法肌力测试。为了恢复活动范围，所有受试者在住院期间每天接受治疗，门诊时根据需要进行治疗。40例清扫术中12例（30%）术后出现前锯肌麻痹。术后第六个月，所有麻痹肩部的力量均恢复正常。在每次评估中，麻痹组和非麻痹组的活动范围相当。讨论了胸长神经损伤的机制、前锯肌麻痹的临床意义以及早期发现和适当物理治疗管理的基本原理。本研究表明，前锯肌麻痹是腋窝淋巴结清扫术后常见但可逆的事件。
