Distribution Characteristics Of Supraclavicular Nerve And Clinical Value Of Its Intraoperative Protection

Background and objective:Supraclavicular nerve supplies the sensation on the surface of the clavicle,the anterior chest,and the shoulder.All operations involving the supraclavicular nerve may result in the nerve injury.At present,some scholars seek for the "protection area" of the supraclavicular nerve through anatomical methods,and explore the significance of intraoperative protection of the supraclavicular nerve through clinical trials,but whether the protection of the supraclavicular nerve is necessary is still controversial.In this study,the supraclavicular nerve was separated and observed during brachial plexolysis through the supraclavicular approach,and the distribution characteristics of the supraclavicular nerve in the middle region of the clavicle were summarized.In addition,the patients with neurogenic thoracic outlet syndrome that protected the supraclavicular nerve and those with middle clavicular fracture that cut off the supraclavicular nerve were followed up for the recovery of skin sensation in the mid-clavicular region after surgery,so as to explore the clinical value of intraoperative protection of the supraclavicular nerve.Methods:We chose the 20 patients diagnosed with neurogenic thoracic outletsyndrome and the surgical treatment were performed through the supraclavicular approach with protection of the supraclavicular nerve and other 20 middle clavicle fracture patients that were treated through the traditional transverse incision with supraclavicular nerves cut off from China-Japan Union Hospital of Jilin University during September 2017 to September 2018.The number of the supraclavicular nerve branches in the middle clavicle region were recorded in 20 cases of neurogenic thoracic outlet syndrome,and the total cross-sectional area of the supraclavicular nerve in this region was calculated to analyze the distribution characteristics of the supraclavicular nerve.We followed up the supraclavicular nerves protected group of 20 cases with NTOS and the supraclavicular nerves cut off group of 20 cases with middle clavicle fracture 6 months postoperatively.And we checked the skin feeling in the middle area of the clavicle,compared and analysed the incidence of paresthesia,paresthesia degree,the consciousness of paresthesia,its influence on the daily life and the VAS pain scores between the two groups to explore the clinic value of supraclavicular protection during the approaches.Results:1.The number of branches of the supraclavicular nerve in the middle clavicle region was 2 ~ 6,with an average of 3.35 branches.The total cross-sectional area of all branches ranged from 0.38 mm2 to 10.69mm2,with an average of 4.02mm2.2.In NTOS group which protected supraclavicular nerves,incidenceof the paresthesia of the skin across the area(P < 0.001),paresthesia degree(P < 0.001),consciousness of the paresthesia(P=0.001),its influence on daily life(P=0.006)and VAS pain score of middle clavicle area(P=0.038)were lower than middle clavicle fracture group that cut off the supraclavicular nerve,and the difference is statistically significant.Conclusion:1.The number of branches of the superior clavicular nerve in the middle clavicle region is variable,and the total cross-sectional area of the nerves are quite different.The distribution of the supraclavicular nerve makes it necessary to protect it during the approaches.2.Indicators in the middle clavicle area after surgery,such as the incidence and degree of skin paresthesia,consciousness of paresthesia,its influence on daily life and VAS pain score in the NTOS group that protected the supraclavicular nerve were all better than those in the middle clavicular fracture group that cut off the supraclavicular nerve.Therefore,it is important to protect the supraclavicular nerve during operations.