中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (53): 8573-8578.doi: 10.3969/j.issn.2095-4344.2015.53.008

• 骨科植入物 orthopedic implant • 上一篇    下一篇

锁骨骨折钢板内固定中锁骨上神经的游离保护

徐瑞达1，2，李晓淼1，2，程光齐1，2，韩晓峰1，2   

  1. 1上海交通大学医学院附属仁济医院南院骨科，上海市 201112；2上海交通大学医学院附属仁济医院骨科，上海市 200127
  • 收稿日期:2015-11-18 出版日期:2015-12-24 发布日期:2015-12-24
  • 通讯作者: 韩晓峰，硕士，主治医师，上海交通大学医学院附属仁济医院南院骨科，上海市 201112；上海交通大学医学院附属仁济医院骨科，上海市 200127
  • 作者简介:徐瑞达，男，1984年生，浙江省宁波市人，汉族，2010年上海交通大学医学院毕业，硕士，医师，主要从事创伤及脊柱外科研究。
  • 基金资助:
    2012年度“上海青年医师培养资助计划”

Supraclavicular nerve dissection and protection in plate internal fixation of clavicle fracture

Xu Rui-da1,2, Li Xiao-miao1, 2, Cheng Guang-qi1, 2, Han Xiao-feng1, 2   

  1. 1Department of Orthopedics, Southern Division, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201112, China; 2Department of Orthopedics, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • Received:2015-11-18 Online:2015-12-24 Published:2015-12-24
  • Contact: Han Xiao-feng, Master, Attending physician, Department of Orthopedics, Southern Division, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201112, China; Department of Orthopedics, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • About author:Xu Rui-da, Master, Physician, Department of Orthopedics, Southern Division, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201112, China; Department of Orthopedics, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • Supported by:

    the Shanghai Young Physician Training Program in 2012

PDF

511

被引次数

2

摘要：

背景：切开复位钢板内固定已经成为锁骨骨折主要的修复治疗方法，而这种方法常造成术后局部皮肤麻木及感觉下降。内固定过程中如何进行锁骨上神经游离的保护，其效果目前有争议。
目的：探讨锁骨骨折切开复位钢板内固定对中锁骨上神经游离保护的临床意义。
方法：将锁骨中段三分之一骨折的57例患者随机分为对照组(n=34)及神经保护组(n=23)，均进行钢板内固定治疗，其中神经保护组在内固定过程中进行锁骨上神经游离保护。术后1年进行电话随访，比较两组患者内固定后局部麻木发生率、麻木严重程度、面积大小、对生活的影响程度及麻木程度改善情况、疼痛等。
结果与结论：两组患者均有17例获得随访。在症状最严重时对照组所有患者100%出现了局部麻木情况，而神经保护组有16例(94%)发生麻木。到随访时对照组有7例(41%)，神经保护组有3例(18%)残留轻度麻木症状，但差异无显著性意义(P > 0.05)。麻木的严重程度、对生活的影像程度等随着时间的推移均有改善。提示锁骨骨折内固定后局部皮肤感觉麻木是发生率较高的并发症，术中游离锁骨上神经保护对于远期麻木症状改善可能有一定效果但不如预期。 

关键词: 骨科植入物, 骨植入物, 锁骨上神经, 神经保护, 锁骨骨折, 钢板内固定, 锁定加压钢板, 术后并发症, 麻木, 皮肤感觉下降

Abstract:

BACKGROUND: Open reduction and plate internal fixation has become a major repair and treatment method for clavicle fracture, however, this method often causes postoperative local skin numbness and hypoesthesia. Currently, there was still controversial about the effect of internal fixation on the free protection of supraclavicular nerve.
OBJECTIVE: To investigate the clinical significance of supraclavicular nerve dissection and protection on open reduction and plate internal fixation of clavicle fracture.
METHODS: Totally 57 patients with the middle third of the clavicle fracture were randomly divided into control group (n=34) and nerve protection group (n=23). Patients in these two groups all underwent plate internal fixation treatment. Patients in the nerve protection group underwent precious identifications and dissections of supraclavicular nerve when approaches were being done, carefully protections in the process of internal fixation. The incidence of local numbness, numbness severity, size, degree of influence on life, the improvement of the degree of numbness and pain were compared during the telephone follow-up after 1 year of surgery.
RESULTS AND CONCLUSION: Totally 17 patients were followed up in each group. At the time of most serious symptom, 100% of all patients appeared local numbness in the control group, while 16 (94%) patients affected numbness in the nerve protection group. Until the latest follow-up, the number of patients with mild numbness symptoms decreased to 7 (41%) in control group and 3 (18%) in the nerve protection group, but there was no significant difference between the two groups (P > 0.05). The severity of numbness and the degree of influence on daily life all improved over time. These results suggest that local skin numbness is a higher incidence of complications after the internal fixation for clavicle fracture. The protection of the supraclavicular nerve may help the improvement of the long-term numbness symptoms, but not as good as expected. 

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