결절종에 의한 견갑상신경 포착 증후군

Suprascapular Nerve Entrapment Syndrome Caused by Ganglion

목적 : 결절종에의해발생한견갑상 신경포착증후군환자에서수술적치료후결과를분석하고치료방법의개선을찾고자하였다. 대상및방법 : 1996년3월부터2001년5월까지진찰소견, 근전도, 자기공명영상소견에서결절종에의한견갑상신경포착증후군으로진단받은 13명의환자를대상으로하였다. 수술은결절종의개방적절제및감압술과관절경하검사를시행하였으며수술후의평가는근력의주관적인회복정도와American shoulder elbow surgeon (ASES)의평가법을이용하여분석하였다. 결과 : 수술후9예(69$\%$)에서간헐적인동통, 근력의불완전회복, 근위축의잔류로인한증상의지속소견이관찰되었으며4예(31$\%$)에서증상의완전회복소견을보였다. 수술후ASES 점수는평균86.4(70$\~$99.8)점이었으며수술전에비해수술후84$\%$의환자에서동통의호전과53$\%$의환자에서근력의호전을보였으나근위축은남아있었다. 결론 : 결절종에의한견갑상신경포착증후군은결절종의절제만으로는증상의완전한해소를기대하기어려우며, 수술시결절종에의한주병변이외에포착이다발성으로발생할가능성이있으므로결절종의제거및관절내병변의치료와함께견갑상절흔과견갑하절흔부위에서의신경에대한감압술을함께고려하는것이좋을것으로생각한다.

Purpose : To review the operative results and find out better method of a treatment of suprascapular nerve entrapment syndrome caused by ganglion. Materials and Methods : From March of 1996 to May of 2001, thirteen cases of suprascapular nerve entrapment syndrome caused by ganglion were reviewed which were diagnosed using physical examination, EMG and MRI. All of them were treated with open exision of ganglion, nerve decompression and arthroscopic examination. The clinical results were evaluated using subjective recovery of muscle power and ASES (American Shoulder and Elbow Surgeons) score. Results : Nine cases (69$\%$) showed residual symptom such as intermittent pain, insufficient recovery of muscle power, persistent muscle atrophy. Complete recovery in four cases (31$\%$). Mean value of ASES score was 86.4 (70-99.8) points. Postopertively, pain was relieved in 84$\%$ of patients and muscle power was improved in 53$\%$ of the patients but the atrophy persisted. Conclusions : Excision of ganglion is insuffient to relieve the nerve entrapment. Not only excision of ganglion but also treatment of intraarticular lesion, decompression of suprascapular and spinoglenoid notch which attributable to entrapment should be considered for the better clinical results.