Clinical treatment of simultaneous lesions of rotator cuff and axillary nerve caused by shoulder dislocation

目的：探讨肩关节脱位同时合并肩袖、腋神经损伤时的机制、诊断和治疗方法选择。方法选择2010年1月至2013年3月在青岛大学附属医院骨科中心收治的6例肩关节脱位同时合并肩袖、腋神经损伤患者。经关节镜下肩袖修复术及营养神经、物理治疗或腋神经探查、神经外膜松解，术后应用美国肩与肘医师协会评分（ ASES）、视觉模拟评分（ VAS）和Constant－Murley评分对患者进行双重功能评分，进行配对t检验统计学分析。结果6例患者均获得随访，平均随访10个月（7～15个月）。术前ASES、VAS、Constant－Murley评分分别为（49．3±8．7）、（7．5±1．0）、（51．2±9．2）分，术后末次随访时分别为（87．0±5．5）、（1．3±1．0）、（88．8±5．0）分，三种评分的手术前后均存在统计学差异（P＜0．05）。结论肩关节脱位同时合并肩袖、腋神经损伤时诊断较为困难，容易漏诊和误诊，应引起重视；应在积极修复肩袖损伤的同时行理疗、营养神经治疗，仍可取得满意的疗效。Objective To investigate the mechanisms,diagnosis and surgical choices of simultaneous lesions of the rotator cuff and the axillary nerve caused by shoulder dislocation.Methods Six patients presented rotator cuff tear associated with axillary nerve injury caused by shoulder dislocation were selected during February 2010 to March 2013 in orthopaedic center of the Affiliated Hospital of Qingdao University.All the patients were assessed and analyzed by visual analogue scale ( VAS), American shoulder & elbow surgeons ’ score ( ASES ) and the Constant-Murley score ( CMS ) after arthroscopic rotator cuff repair or surgical neurolysis of axillary nerve.Results All the six patients were followed up for seven to 15 months with the average of 10 months.Visual analog scale ( VAS) score, ASES score and CMS score were significantly different between the preoperation and the postoperation ( P <0.05).Conclusions It’s difficult to diagnosis the simultaneous lesions of the rotator cuff and the axillary nerve caused by shoulder dislocation; orthopedists should pay attention to the possible patient in order to avoid missed diagnosis and diagnostic errors.Nerve nutrition, physical therapy and arthroscopic rotator cuff repair can also achieve good effectiveness.中国科技核心期刊(ISTIC)5579-58