术中保护锁骨上神经对锁骨骨折愈合率的影响  

Effect of intraoperative protection of the supraclavicular nerve on healing of clavicular fracture

作　　者：孙嘉兴 胡长青[1] 朱蕾[1] 陆芳[1] 郭兰 李珊 马稳稳 于洋 Sun Jiaxing;Hu Changqing;Zhu Lei;Lu Fang;Guo Lan;Li Shan;Ma Wenwen;Yu Yang(Department of Orthopaedics,The First Central Hospital of Baoding,Baoding 071000,China)

机构地区：[1]河北省保定市第一中心医院骨科,保定071000

出　　处：《中华创伤骨科杂志》2024年第5期449-454,共6页Chinese Journal of Orthopaedic Trauma

基　　金：河北省医学科学研究课题(20220292)。

摘　　要：目的探讨保护锁骨上神经后对锁骨中段1/3骨折愈合率的影响。方法回顾性分析2021年6月至2022年3月就诊于保定市第一中心医院骨科的83例锁骨中段1/3骨折患者资料。男57例,女26例;年龄(48.1±12.8)岁。将患者按术中是否保护锁骨上神经分为2组:观察组(术中游离、保护锁骨上神经)39例,对照组(术中不保护锁骨上神经)44例。记录并比较两组患者手术切口长度、手术时间、术中出血量,术前及术后3、6、12个月疼痛视觉模拟评分(VAS)、骨折愈合情况及术后并发症情况。同时记录和比较术后6周观察组8例患者患侧与健侧肩部锁骨中段微血管数量。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。观察组患者手术时间[(72.2±5.4)min]显著长于对照组[(61.1±4.7)min],术后3、6个月观察组患者VAS评分[2.7(2.4,3.1)、2.1(1.9,2.6)分]显著低于对照组[3.5(3.2,3.8)、2.7(2.4,2.9)分],术后3、6个月观察组患者骨折愈合率分别为97.4%(38/39)、100%(39/39)均显著优于对照组81.8%(36/44)、86.4%(38/44),以上项目两组间比较差异均有统计学意义(P<0.05)。术后12个月两组患者骨折愈合率比较差异无统计学意义(P>0.05)。观察组8例患者术后6周患侧与健侧肩部造影显示锁骨中段微血管数量分别为(85.3±0.7)、(87.1±0.8)支,差异无统计学意义(P>0.05)。术后观察组与对照组分别出现3、4例切口延迟愈合,9、26例切口周围皮肤感觉异常,两组间比较差异有统计学意义(P<0.05)。结论术中保护神经有利于减轻患者术后早期疼痛,提高早期的骨折愈合率,并可能对术后微血管网络的重建存在一定积极影响。Objective To investigate the effect of intraoperative protection of the supraclavicular nerve on the healing of clavicular 1/3 mid-shaft fracture.Methods A retrospective study was conducted to analyze the 83 patients who had been treated for clavicular 1/3 mid-shaft fractures at Department of Orthopaedics,The First Central Hospital of Baoding from June 2021 to March 2022.There were 57 males and 26 females with an age of(48.1±12.8)years.The patients were divided into 2 groups according to whether the supraclavicular nerve was protected or not during operation.There were 39 cases in the observation group(the supraclavicular nerve was protected during operation)and 44 cases in the control group(the supraclavicular nerve was not protected during operation).The incision length,operation time,intraoperative blood loss,hospital stay,visual analogue scale(VAS)pain scores before operation and 3,6 and 12 months after operation,fracture healing at 3,6 and 12 months after operation,and postoperative complications were recorded and compared between the 2 groups.Additionally,the number of microvessels in the middle clavicle was recorded and compared between the affected and healthy sides in 8 patients in the observation group at 6 weeks after operation.Results There was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).The operation time for the observation group[(72.2±5.4)min]was significantly longer than that for the control group[(61.1±4.7)min].The VAS scores at postoperative 3 and 6 months for the observation group[2.7(2.4,3.1)and 2.1(1.9,2.6)points]were significantly lower than those for the control group[3.5(3.2,3.8)and 2.7(2.4,2.9)points](P<0.05).The fracture healing rates at postoperative 3 and 6 months in the observation group[97.4%(38/39)and 100%(39/39)]were significantly higher than those in the control group[81.8%(36/44)and 86.4%(38/44)](P<0.05),but there was no significant difference in the fracture healing between the 2 groups at 12 months after op

关 键 词：锁骨骨折 骨折固定术 内 骨折愈合 血管造影术 神经组织 

分 类 号：R687.3[医药卫生—骨科学]