保护锁骨上神经在锁骨骨折固定术中的应用  

Preservation of supraclavicular nerve in fixation of clavicular fracture

作　　者：潘希彬 魏宽海[2] 官龙洲 蔡国雄 陈滨[2] 钟云祥 黄少泉 张俭 谢延华 Pan Xibin;Wei Kuanhai;Guan Longzhou;Cai Guoxiong;Chen Bin;Zhong Yunxiang;Huang Shao-quan;Zhang Jian;Xie Yanhua(Department of Orthopedics and Traumatology,Heyuan Hospital of Traditional Chinese Medicine,Heyuan 517000,Guangdong,China;Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广东省河源市中医院骨科,517000 [2]南方医科大学南方医院骨科,广州510515

出　　处：《中华创伤骨科杂志》2020年第4期351-355,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨保护锁骨上神经在锁骨骨折复位固定术中的应用。方法回顾性研究2016年10月至2018年4月广东省河源市中医院骨科采用手术治疗的68例锁骨骨折患者资料。男35例,女33例;年龄25~45岁,平均34.8岁。根据手术方法不同分为保护组(锁骨骨折复位固定术中保护锁骨上神经,32例)和对照组(锁骨骨折复位固定术中不保护锁骨上神经,36例)。比较两组患者的手术时间、术中出血量、骨折愈合时间、术后疼痛耐受程度、感觉(参照英国医学研究会评定标准)、患肩功能(Constant-Murley评分)、麻木对生活的影响。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。68例患者均获随访,时间12~26个月(平均15个月)。两组患者术中出血量、骨折愈合时间比较差异均无统计学意义(P>0.05)。保护组患者的手术时间[(72.6±7.2)min]长于对照组[(47.3±7.4)min],术后当天止痛药使用率[6.3%(2/32)]低于对照组[91.7%(33/36)],差异均有统计学意义(P<0.05)。术后感觉参照英国医学研究会评定标准:保护组4、3级占93.8%(30/32),高于对照组的72.2%(26/36);保护组患肩的Constant-Murley评分[100.0(93.5,100.0)分]高于对照组[87.0(81.0,89.0)分],麻木对生活的影响率(0)低于对照组(50.0%,18/36),差异均有统计学意义(P<0.05)。结论在锁骨骨折手术治疗中,与不保护锁骨上神经比较,保护锁骨上神经的疗效是肯定的,且可以明显减轻术后术区疼痛及麻木对生活的影响。Objective To investigate the clinical significance of preserving supraclavicular nerve in the reduction and fixation of clavicular fracture.Methods A retrospective study was conducted of the 68 pa-tients with clavicular fracture who had been treated surgically from October 2016 to April 2018 at Department of Orthopedics and Traumatology,Heyuan Hospital of Traditional Chinese Medicine.They were 35 males and 33 females,aged from 25 to 45 years(average,34.8 years).The supraclavicular nerve was preserved in the re-duction and fixation of clavicular fracture in 32 patients(reservation group)but not in the other 36 ones(control group).The 2 groups were compared in terms of operation time,intraoperative blood loss,fracture healing time;postoperative pain tolerance,feeling(by the British Medical Research Council assessment),shoulder function(by the Constant-Murley scoring)and impact of numbness on life.Results The 2 groups were compatible due to insignificant differences in the general clinical data between them(P>0.05).All the 68 patients were followed up for 12 to 26 months(average,15 months).There was no significant difference between the 2 groups either in intraoperative blood loss or fracture healing time(P>0.05).The preservation group had significant longer operation time(72.6 min±7.2 min)than the control group(47.3 min±7.4 min),but a significantly lower rate of analgesic usage on the postoperative day[6.3%(2/32)]than the control group[91.7%(33/36)](both P<0.05).By the British Medical Research Council assessment,the postoperative feeling was rated as S3 or S4 in 93.8%(30/32)of the patients in the preservation group,significantly higher than the 72.2%(26/36)of the control group(P<0.05).The preservation group was also significantly better than the control group in Constant-Murley scores of the injured shoulder[100.0(93.5,100.0)versus 87.0(81.0,89.0)]and impact of numbness on life[0 versus 50.0%(18/36)](both P<0.05).Conclusion In surgical treatment of clavicular fracture,preservation of the supraclavicular nerve can

关 键 词：锁骨 骨折 麻木 锁骨上神经 感觉障碍 

分 类 号：R687[医药卫生—骨科学]