Antoniadis G, Richter H P, Rath S, Braun V, Moese G
Department of Neurosurgery, University of Ulm, Guenzburg, Germany.
J Neurosurg. 1996 Dec;85(6):1020-5. doi: 10.3171/jns.1996.85.6.1020.
Suprascapular nerve entrapment (SNE) in the suprascapular notch is a rare entity that must be considered in the differential diagnosis of radicular pain, as well as that of shoulder discomfort. Over a period of 10 years (1985-1995), the authors treated 28 cases of SNE in 27 patients by surgical decompression of the nerve. One patient underwent operation bilaterally within 5 years. Five patients presented with a history of trauma to the shoulder region. In three patients, a ganglion cyst was the origin of the nerve lesion. In 16 patients, the nerve problem was primarily related to athletic activities. Eight of these patients were professional volleyball players. In the remaining three patients, there was no relationship between the nerve lesion and trauma or athletic activities. Twenty-one patients (22 cases) complained of pain located over the suprascapular notch. Seventeen patients had paresis and atrophy of both the supraspinatus (SS) and infraspinatus (IS) muscles. In 10 patients only the IS muscle was involved. One patient exhibited a sensory deficit over the posterior portion of the shoulder. Electromyography was performed in all cases. The mean follow-up period in the 25 cases (24 patients) that could be evaluated was 20.8 months (range 3-70 months). Nineteen of 22 cases with preoperative pain could be evaluated. Sixteen of these patients were completely free of pain after surgery and three patients found their pain had improved. Motor function in the SS muscle improved in 86.7% and motor function in the IS muscle in 70.8% of cases. Atrophy of the SS muscle resolved in 80.7% and atrophy of the IS muscle in 50% of cases. Surgical treatment of SNE is indicated after failed conservative treatment and in cases of atrophy of the SS and IS muscles. The authors recommend the posterior approach, which minimizes risks and complications and produces good postoperative results.
肩胛上切迹处的肩胛上神经卡压（SNE）是一种罕见疾病，在神经根性疼痛以及肩部不适的鉴别诊断中均应予以考虑。在10年期间（1985 - 1995年），作者通过对神经进行手术减压治疗了27例患者的28例SNE。1例患者在5年内双侧接受了手术。5例患者有肩部区域创伤史。3例患者中，神经病变起源于腱鞘囊肿。16例患者中，神经问题主要与体育活动有关。其中8例患者为职业排球运动员。其余3例患者中，神经病变与创伤或体育活动无关。21例患者（22例）主诉肩胛上切迹处疼痛。17例患者冈上肌（SS）和冈下肌（IS）均出现麻痹和萎缩。10例患者仅累及IS肌。1例患者肩部后部出现感觉障碍。所有病例均进行了肌电图检查。可评估的25例（24例患者）的平均随访期为20.8个月（范围3 - 70个月）。22例术前疼痛的病例中有19例可进行评估。其中16例患者术后完全无痛，3例患者疼痛有所改善。SS肌的运动功能在86.7%的病例中得到改善，IS肌的运动功能在70.8%的病例中得到改善。SS肌萎缩在80.7%的病例中得到缓解，IS肌萎缩在50%的病例中得到缓解。经保守治疗无效以及出现SS肌和IS肌萎缩的病例，均需进行SNE的手术治疗。作者推荐采用后路手术，该方法可将风险和并发症降至最低，并产生良好的术后效果。
