| Clinically,the number of clavicle fracture patients caused by various kinds of trauma has gradually shown an increasing trend,especially the number of middle-aged and young patients is increasing.In recent years,with the improvement of medical equipment and the demand for rapid rehabilitation of fracture patients,more and more patients with clavicular fracture choose surgery.At present,open reduction and internal fixation for clavicle fracture is the most common operation in clinic.With the development of clinical research,it has been found that there may be a variety of complications,among which the most common complication is numbness in the distal incision area,and this symptom seriously affects the postoperative quality of life of patients.In order to solve this complication,clinical workers have gradually attached importance to the problem of iatrogenic injury in supraclavicular nerve surgery.Therefore,more and more clinical workers put forward the idea of avoiding injury to the supraclavicular nerve during operation,and the improvement of traditional open reduction plate internal fixation has been gradually put forward.Objective:To observe the distribution of the supraclavicular nerve in the supraclavicular region and the clinical effect of intraoperative protection for patients with clavicle fracture of the supraclavicular nerve,thus to provide a certain reference for clinical research.Method:A prospective study was conducted.A total of 60(n = 60)patients with clavicle fractures in our hospital from August 2017 to May 2018 were selected,including 42 males and 18 females,aged from 18 to 46 years.The patients were randomly divided into two groups,the observation group(intraoperative dissociation to protect the supraclavicular nerve)and the control group(non-protective supraclavicular nerve).In the observation group,all 30 patients underwent supraclavicular incision.During the operation,each branch of the supraclavicular nerve was carefully separated,fully dissociated and protected of the supraclavicular nerve.At the same time,intraoperative fluoroscopy was used to observe and record the running and distribution of the supraclavicular nerve in the supraclavicular region.The midpoint line at both ends of the clavicle was used as the collarbone transverse axis.Take the ful length of the collarbone transverse axis as unit "1".The medial end of the coll arbone transverse axis was taken as "0" and the lateral end as "1".The kirschner wire marks the branches of the supraclavicular nerve across the superior margin of the clavicle,X-ray images were used to accurately measure the distance from the labeled point of each branch of the supraclavicular nerve to the "0" point;Control group: all 30 patients underwent supraclavicular incision and chose traditional open reduction and plate internal fixation,without protection of supraclavicular nerves.The operation time,intraoperative blood loss and fracture healing of the two groups were compared.Postoperative follow-up was observed for 18 months: the incidence and severity of paresthesia in the surgical area at 2 weeks,1 month,3 months,6 months and 12 months after surgery were record for comparison.The questionnaire was completed during 18 months of post-operative telephone follow-up to compare whether there was any difference in postoperative life satisfaction between the two groups,so as to observe the clinical efficacy.Results:1.Distribution of supraclavicular nerves in the observation group: the anatomy of 30 clavicle regional nerves showed that 15 patients had three branches(internal,middle and external branches),14 patients had two branches(internal and external branches),and 1 patient had one branch(middle branch).The anatomical observation results of 15 patients with three branches by relative measurement method showed that the lateral branch appeared in 0.64±0.081,the intermediate branch appeared in 0.47±0.12,and the medial branch appeared in 0.27±0.08.The anatomic observation results of 14 patients with two branches showed that the lateral branch appeared in 0.61±0.07 and the medial branch appeared in 0.30±0.07.Anatomical observation of one branch showed that the intermediate branch appeared in 0.57.Statistical analysis showed that there was no significant difference in the distribution region of internal and external nerve branches among patients with different number of branches(P>0.05).2.Operation and prognosis of the two groups: all the patients in the two groups successfully completed the operation.The operation time of the intraoperative free nerve protection group was slightly longer than that of the intraoperative non-nerve protection group,and the difference in intraoperative use time between the two groups was statistically significant(P < 0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Postoperative incision healing was grade a in both groups and fracture healing was achieved in all patients.3.The results of the follow-up 2 weeks,1 month,3 months,6 months and 12 months after the operation showed that the rate and degree of abnormal sensation around the incision in the observation group were lower than that in the control group,and the difference was statistically significant(P<0.05).The results of the follow-up questionnaire showed that the patients’ life satisfaction at 18 months after surgery was significantly higher in the observation group than that in the control group,and the difference between the two surgical methods was statistically significant(P < 0.05).Conclusion:(1)The supraclavicular nerve distribution in the supraclavicular region has a certain rule.Mastering this rule can provide certain help for avoiding DE injury of supraclavicular nerve during operation.(2)During the clavicular fracture open reduction and internal fixation,the protection of cutaneous nerve can effectively reduce the occurrence of postoperative local skin sensory abnormalities,the postoperative quality of life of patients and high satisfaction,worthy of clinical promotion. |
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