Zanotti R M, Carpenter J E, Blasier R B, Greenfield M L, Adler R S, Bromberg M B
University of Michigan Shoulder Group, Department of Radiology, Ann Arbor, USA.
J Shoulder Elbow Surg. 1997 May-Jun;6(3):258-64. doi: 10.1016/s1058-2746(97)90014-8.
We measured the incidence of cuff retear and injury to the suprascapular nerve after mobilization and repair of a massive rotator cuff tear. Of one hundred four rotator cuff repairs performed over a 5-year period, 10 patients (7 men and 3 women, age range 22 to 68 years) had primary repairs of massive rotator cuff tears requiring cuff mobilization and an acromioplasty as their only procedure. These patients were evaluated at a mean of 2.5 years (range 2.0 to 3.0 years) after surgery. At follow-up electromyographic examination confirmed that 1 of the 10 patients had an iatrogenic suprascapular nerve injury, whereas ultrasound evaluation revealed that 2 of 10 repairs failed. Pain relief was achieved in the eight patients with intact repairs and not in the two with recurrent tears. All patients had some limitation of active motion or strength, especially in external rotation. Thus 7 of 10 patients had neither evidence of nerve injury nor recurrent rotator cuff tears yet still showed limited active motion or weakness. It appears that operative injury to the suprascapular nerve during cuff mobilization can occur, but other factors such as inadequate cuff muscle function are more frequently responsible for the poor functional outcomes seen after successful repairs of massive rotator cuff tears.
我们测量了巨大肩袖撕裂伤经动员和修复后袖带再撕裂及肩胛上神经损伤的发生率。在5年期间进行的104例肩袖修复术中，10例患者（7例男性和3例女性，年龄范围22至68岁）对巨大肩袖撕裂伤进行了初次修复，仅需进行袖带动员和肩峰成形术。这些患者在术后平均2.5年（范围2.0至3.0年）接受评估。随访时的肌电图检查证实，10例患者中有1例发生医源性肩胛上神经损伤，而超声评估显示10例修复中有2例失败。修复完好的8例患者疼痛得到缓解，而2例再撕裂患者疼痛未缓解。所有患者均存在一定程度的主动活动或力量受限，尤其是外旋。因此，10例患者中有7例既无神经损伤迹象，也无肩袖再撕裂，但仍表现出主动活动受限或无力。似乎在袖带动员过程中可能会发生肩胛上神经的手术损伤，但其他因素，如袖带肌肉功能不足，更常导致巨大肩袖撕裂伤成功修复后出现功能不良的结果。
