鏡視下上肩甲横靭帯切離術の臨床成績と MRI による筋萎縮の評価

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We have performed arthroscopic release of the suprascapular nerve (SSN) in patients with sensory disturbance of the SSN area since 2006. The purpose of this study is to investigate the clinical outcome and postoperative change of the supraspinatus and infraspinatus muscle atrophy using MRI. Twenty shoulders (10 men and 10 women, average age: 63.8 years (range, 41-77)) were followed for more than 1 year and included in this study. Associated diagnoses were 14 cuff tears (5 incomplete tears, 3 medium tears, 2 large tears, and 4 massive tears), 2 frozen shoulders, 3 rheumatoid arthritis, and 2 cuff tear arthropathy. For these conditions, additional procedures (5 ARCR, 6 ORCR, 3 humeral head replacement, 1 ASD, and 2 TSA) were performed simultaneously. JOA score and sensory disturbance were evaluated pre- and postoperatively. To evaluate muscle atrophy, the occupation ratio (OR) of supraspinatus and infraspinatus was measured in sagittal view of MRI. More than 10% increase of postoperative OR was defined as improvement; more than 10% decrease as progress. The follow-up period was 12-30 months (avg. 18.5). JOA score improved from 51.1 to 90.5 points postoperatively. The sensory disturbance disappeared postoperatively in all shoulders. In the supraspinatus, preoperative OR was more than 75% in 1 shoulder, 50-75% in 7, and 25-50% in 12; in the infraspinatus, more than 75% in 8 shoulders, 50-75% in 8, 25-50% in 3, and less than 25% in 1. Postoperative OR of the supraspinatus improved in 8 shoulders (40%) and progressed in 2; postoperative OR of the infraspinatus improved in 6 (30%) and progressed in 2. The sensory disturbance and pain improved in all shoulders. Improvement of muscle atrophy was observed even in shoulders with severe atrophy (OR < 50%) in the supraspinatus. Arthroscopic release of SSN is considered useful in improvement of not only pain and sensory disturbance but also muscle atrophy.

鏡視下上肩甲横靭帯切離術の臨床成績と MRI による筋萎縮の評価

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