关节镜下经后关节囊切开减压治疗冈盂切迹囊肿引起的肩胛上神经卡压综合征  

Clinical treatment of suprascapular nerve compression syndromes via posterior portal by arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve

作　　者：刘炜洁 蔡琰 戚超[1] 于腾波[1] 陈伯华[1] 赵夏[1] 汪健 Liu Weijie, Cai YaM, Qi Chao, Yu Tengbo, Chen Bohna, Zhao Xia, Wang Jian(Department of Orthopaedics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China （Liu W J, Qi C, Yu TB, Chen BH, Zhao X, Wang J）; Department of Medicine, Qingdao Municipal Hospital, Qingdao 266071, China （Cai Y）)

机构地区：[1]青岛大学附属医院骨科,266003 [2]青岛市立医院内科,266071

出　　处：《中华骨科杂志》2018年第7期390-395,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨肩关节镜下经后关节囊切开入路冈盂切迹囊肿减压及肩胛上神经松解治疗肩胛上神经卡压综合征的疗效。方法2010年1月至2017年1月收治肩胛冈盂切迹囊肿引起的肩胛上神经卡压综合征患者11例，男7例，女4例；年龄29—56岁，平均（41．5±5．3）岁。左侧3例，右侧8例。所有病例均经肩关节MR检查及肌电图检查确诊。MRI示冈盂切迹处囊肿，直径0．5-2．6cm，平均（1．5±0．7）cm；其中3例合并上盂唇前后部（superior labrum anterior and posterior，SLAP）损伤，均为Snyder分型Ⅱ型。于肩关节镜监视下，将后上方关节囊沿盂唇外缘分离，显露囊肿外壁并切开，扩大囊肿外壁裂口，使囊液向关节内形成引流，小心分离肩胛上神经血管束，松解肩胛上神经。合并SLAP损伤者以可吸收锚钉缝合固定后上盂唇。术后口服营养神经药物3个月。术前及术后随访采用美国肩与肘医师协会（American Shoulder Elbow Surgeons，ASES）评分和Constant—Mudey评分评估肩关节功能。结果术中囊肿切开后可见淡黄色液体流出，探查囊肿内壁与肩胛上神经、邻近血管，证实囊肿压迫是引起肩胛上神经卡压的原因。11例患者均获得随访，随访7-15个月，平均10个月。术前及末次随访时ASES评分分别为（46．5±3．7）分和（93．8±2．2）分，差异有统计学意义（t=3．359，P=0．000）；术前ASES评分良5例、可4例、差2例，术后全部为优。术前及末次随访时Constant-Mudey评分分别为（47．3±4．2）分和（94．0±1．8）分，差异有统计学意义（t=4．776，P=0．000）；术前良6例、可5例，术后全部为优。所有患者术中均未发生臂丛牵拉或灌洗液外渗造成颈胸背筋膜腔水肿等并发症。随访期间无关节感染或其他并发症出现。术后6个月时肌电图未提示神经损伤，MRI未见囊肿复发。患者均重返伤前工作岗位，对治疗效果�Objective To investigate the clinical outcomes of arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve in treating suprascapular nerve compression syndromes via posterior portal. Methods Eleven patients from January 2010 to January 2017 with spinoglenoid notch cysts complicated suprascapular nerve compression syndromes were included. There were 7 males and 4 females with the average age of 41.5±5.3 years old （range 29-56 years） with 3 patients left side involved and 8 right side. All patients were diagnosed with MRI and EMG. The surgical procedure began with posterior capsule arthroscopic releasement from the labrum, then found the spinoglenoid notch cyst. Split of the cyst was made for interhal drainage, then found the suprascapular nerve and vessel bundle for clearing the bursal tissue with probe, decompressed the suprascapular nerve finally. Mecobalamin was taken （0.5 mg, rid） until 3 months postoperatively. The patients were evaluated by functional scores from American Shoulder Elbow Surgeons （ASES） and Constant-Murley preoperatively and postoperatively. Statistical analysis was conducted by student t-test. Results All patients were followed up at 7-15 months （with an average of 10 months）. The mean preoperative ASES score increased from 46.5±3.7 to 93.8±2.2 at the time of final follow-up with the significant difference （t=3.359, P〈0.05）. Preoperative ASES score were good in 5 cases, fair in 4 cases and poor in 2 cases. The postoperative score were excellent in all patients. The Constant-Murley score was 47.3±4.2 preoperatively and 94.0±1.8 postoperatively with sig- nificant difference （t=4.776, P〈0.05）. Preoperative score were good in 6 cases and fair in 5 cases. The postoperative score were ex- cellent in all patients. These patients had no recurrence of cyst after surgery and returned to wock. Conclusion Arthroscopic decompression of spinlglenoid notch cyst and supraseapular nerve release via posterior portal can successfully treat supra

关 键 词：肩 关节镜检查 囊肿 神经卡压综合征 

分 类 号：R687.4[医药卫生—骨科学]