锁骨骨折内固定术中改良游离方式保护锁骨上神经的效果

Effect of Modified Free Approach to Protect the Supraclavicular Nerve During Internal Fixation of Clavicle Fractures

目的探讨锁骨骨折术中对锁骨上神经进行保护的效果。方法回顾性分析2018年7月至2020年1月医院收治的64例锁骨骨折患者的临床资料,根据术中神经处理方式不同分为两组,每组32例,传统切断组32例,神经保护组32例,比较两组的手术时间、骨折愈合时间、患肩术后功能及返回工作岗位的时间、末次随访患肩麻木情况及对生活的影响等。结果所有患者均获得随访,随访时间9~22个月,平均13个月。两组术前一般资料比较,差异无统计学意义(P>0.05)。神经保护组手术用时长于传统组,差异有统计学意义(P<0.05);神经保护组术后肩功能评分高于传统组,差异有统计学意义(P<0.05);两组术中出血量、骨折愈合时间及返回工作岗位时间比较,差异无统计学意义(P>0.05);末次随访,两组残留麻木不适方面比较,差异有统计学意义(P<0.05)。结论保护锁骨上神经虽增加了手术时长,但能够减轻锁骨骨折术后肩部麻木不适感,使患者获得良好的肩关节功能。

Objective To explore the effect of protecting the supraclavicular nerve in the operation of clavicular fracture.Methods From July 2018 to January 2020,a total of 80 patients with clavicular fracture in the study were analyzed retrospectively.According to the inclusion and exclusion criteria,a total of 64 patients were included in the study,and were divided into two groups according to the different ways of nerve management during operation.Thirty-two patients in the traditional amputation group and 32 patients in the neuro-protection group.The time of operation,the time of fracture healing,the postoperative shoulder function,the time of returning to work,the effect of postoperative numbness on life at the last follow-up were compared between the two groups.Results All patients were followed up for 9~22 months(mean 13 months).There was no significant difference in preoperative general data.The operation time of the protective group was longer than that of the traditional group(P<0.05),and the shoulder function score of the protective group was significantly higher than that of the traditional group(P<0.05).There was no significant difference in the amount of bleeding,the time of fracture healing and the time of returning to work between the two groups(P>0.05),and there was significant difference in the residual numbness and discomfort between the two groups at the last follow-up(P<0.05).Conclusion The protection of supraclavicular nerve may increase the operation time,but it can reduce the numbness and discomfort of the shoulder after the operation of clavicular fracture,and make the patients get better shoulder joint function.