巨大肩袖损伤中肩胛上神经病变的诊断与治疗  

Diagnosis and treatment of suprascapular neuropathy with massive rotator cuff tear

作　　者：刘建永[1] 姜鑫[1] Liu Jianyong;Jiang Xin(Department of Orthopaedics,Weifang People＇s Hospital,Weifang 261041,China)

机构地区：[1]山东省潍坊市人民医院关节外科,261041

出　　处：《中华骨科杂志》2018年第17期1055-1062,共8页Chinese Journal of Orthopaedics

基　　金：山东省医药卫生科技发展计划项目（2016Ws0654）;潍坊市卫计委科研项目计划（2016wsjs022）

摘　　要：目的探讨巨大肩袖损伤中肩胛上神经病变的诊断与治疗结果。方法回顾性分析2011年1月至2014年6月采用关节镜下修复治疗的巨大肩袖损伤患者50例，男24例，女26例；年龄（51．50±11．50）岁（范围35～65岁）；病程（4．60±6．70）个月（范围1-57个月）。术前脂肪浸润Goutallier分级：oN3例，1级18例，2级18例，3级9例，4级2例。术前依据病史、体征及神经肌电图检查诊断肩胛上神经病变6例，Goutallier4级2例、3级4例。肩袖修复术前及术中未发现肩胛横韧带及冈盂切迹囊肿压迫肩胛上神经，在关节镜下肩袖修复术后仅给予神经营养药物治疗。术后采用肩关节活动范围（rangeofmotion，ROM），肩前屈上举、体侧外旋、体侧内旋的肌力，疼痛视觉模拟评分（visualanaloguescore，VAS），Con—stant—Murley肩关节功能评分，美国肩肘外科医师协会（AmericanShoulderandElbowSurgeon，ASES）评分以及MRI评价疗效，复查肌电图观察肩胛上神经恢复情况，比较肩胛上神经病变组与无肩胛上神经病变组术前及术后2年的疗效差异。结果术后切口均一期愈合，随访（27．9±6．70）个月（范围24-45个月）。术后2年患者肩前屈上举、体侧外旋、体侧内旋肌力均增加，VAS评分由术前（7．70±2．50）分降至（1．20±1．80）分（t=14．670，P=O．000），ASES评分由术前（45．80±9．50）分提高至（92．50±6．30）分（￡一18．450，P=0．000），Constant—Murley评分由术前（41．40±8．70）分提高至（90．20±4．70）分（t=-20．790，P=0．000）。术前肩胛上神经病变组VAS评分大于无肩胛上神经病变组、ASES评分及Constant．Mudey评分小于无肩胛上神经病变组（P〈0．05），术后2年两组各项评分的差异均无统计学意义（P〉0．05）。结论巨大肩袖损伤中肩胛上神经病变的发生率为12％（6／50），伴有神经病变时肩关节功能更差。�Objective To evaluate diagnosis and treatment outcomes about suprascapular neuropathy with massive rota- tor cuff tear. Methods Fifty patients with massive rotator cuff tear underwent arthroscopic surgery from January 2011 to June 2014. The mean age was 51.50± 11.50 years with average disease duration 4.60±6.70 months. Preoperative fat infiltration Goutalli- er grade was 3 cases in grade 0, 18 in grade 1, 18 in grade 2, 9 in grade 3 and 2 in grade 4. Based on medical history, physical ex- amination and electromyogram, six cases were diagnosed with Neuropathy. Compression of scapular transverse ligament and gan- glion notch cyst were not founded before and during rotator cuff repairing. Only neurotrophic drugs were admitted after arthrosco- py. The clinical outcomes （range of motion, muscle strength in flexion and in rotation, electromyogram, Constant- Murley score, ASES score and VAS） and MRI results were collected. The differences between snprascapular neuropathy and normal group were compared at pre-operation and 2 years after operation. Results There was no complication like axillary nerve injury, infection and instability during the 27.90±6.70 months follow-up. All patients of Goutallier grade 4 （2/2） and partial patients of grade 3（4/9） showed delayed conduction with suprascapular neuropathy. The muscle strength in flexion and bodyside external/internal rotation improved. The VAS decreased from 7.70±2.50 to 1.20± 1.80 （t=14.670, P=0.000）, and ASES score improved from 45.80±9.50 to 92.50±6.30 （t=-18.450, P=0.000）. Furthermore, Constant-Murley score improved from 41.40±8.70 to 90.20±4.70 （t=-20.790, P= 0.000）. Compared with the normal group, the patients with suprascapular neuropathy showed higher pain and worse functional score preoperatively （P〈0.05）. At 2 years after operation, the normal and neuropathy group showed similar pain and function scores （P〉0.05）. Conclusion The incidence of suprascapular neuropathy is 12% （6/50） in patients with massive rotator cu

关 键 词：回旋套 创伤和损伤 关节镜检查 修复外科手术 电生理学 

分 类 号：R687.4[医药卫生—骨科学]