【摘要】：目的:觀察鎖骨骨折切開復(fù)位內(nèi)固定術(shù)后鎖骨區(qū)感覺異常的臨床及解剖學結(jié)果。方法:回顧性分析2013年5月至2016年6月期間在廣西醫(yī)科大學第一附屬醫(yī)院及廣西醫(yī)科大學第二附屬醫(yī)院進行鎖骨骨折切開復(fù)位內(nèi)固定術(shù)的135例病例資料,根據(jù)患者術(shù)后鎖骨區(qū)域感覺異常的臨床癥狀,麻木較顯著的時間,觸碰到其他物體時麻木情況,鎖骨術(shù)區(qū)疤痕疼痛及取出鋼板后對麻木癥狀的改變,隨訪上述事件。在解剖教研室對7具正常人尸體(男性6具、女性1具)進行鎖骨上神經(jīng)解剖,了解鎖骨上神經(jīng)走向、分支及其與臨床關(guān)系。結(jié)果:術(shù)后鎖骨區(qū)感覺異常的發(fā)生率19.25%(n=26/135)。其中16.3%(n=22/135)為麻木,2.8%(n=4/135)為疼痛。其中麻木最顯著的時間為術(shù)后一個月。0.7%(n=1/135)患者訴麻木程度最為嚴重,同時0.7%(n=1/135)的患者為中度麻木及14%(n=20/135)則為輕度麻木。麻木癥狀最顯著的病例中,有2例在接觸衣服及其他異物時麻木感增加,有2例因麻木感而心理受到影響。本組其余病例未因鎖骨區(qū)麻木而感到困惑。1.4%病例為輕度疼痛,0.7%位中度疼痛及0.7%為中度疼痛。98.6%(n133/135)病例隨著時間的推移,麻木感可完全緩解,仍有1.4%病例出現(xiàn)永久性麻木,但其中病例沒有因麻木而感到心里困惑。尸體解剖顯示,鎖骨上神經(jīng)自頸叢從胸鎖乳突肌后緣中下1/2處發(fā)出,即分出內(nèi)中外三支,位于深淺筋膜之間,向遠端越過鎖骨,支配鎖骨周圍感覺。鎖骨上神經(jīng)的三支體表投影大致為胸鎖乳突肌后緣中點分別至胸骨柄外側(cè)、鎖骨中點及肩峰的三條引線。本報告結(jié)果顯示鎖骨上神經(jīng)的三個分支,外側(cè)支在肩峰外側(cè)緣近端約2.26cm、中間支接近鎖骨中點、內(nèi)側(cè)支在胸骨柄外側(cè)緣外側(cè)約2.03cm。結(jié)論:本報告顯示鎖骨骨折內(nèi)固定術(shù)后鎖骨上神經(jīng)損傷及其皮膚感覺減退或過敏性疼痛的病例。大部分術(shù)后出現(xiàn)麻木的病例隨著時間的推移而改善。皮膚感覺減退發(fā)生率較小,有麻木的患者,中后期也有較大程度的改善。但有少部分患者麻木可持續(xù)2年,有的甚至是永久性的麻木。本報告中部分患者因麻木而影響,特意到門診為了感覺異常癥狀等不適就診,所有患者均否認麻木影響到日常生活。在鎖骨骨折切開復(fù)位內(nèi)固定術(shù)及鋼板取出術(shù)中,可涉及鎖骨上神經(jīng)的損害。術(shù)中操作應(yīng)注意分離、保護,盡量避免損傷此神經(jīng)。
[Abstract]:Objective: to observe the clinical and anatomical results of sensory abnormalities in the clavicular region after open reduction and internal fixation of clavicular fractures. Methods: from May 2013 to June 2016, 135 patients with clavicular fracture underwent open reduction and internal fixation in the first affiliated Hospital of Guangxi Medical University and the second affiliated Hospital of Guangxi Medical University were retrospectively analyzed. According to the clinical symptoms, the time of numbness, the numbness when touching other objects, the scar pain in the clavicular region and the changes of numbness after removing the plate, the above events were followed up. The supraclavicular nerve was dissected in 7 normal human cadavers (6 males and 1 female) in the Department of Anatomy to understand the direction of supraclavicular nerve, its branches and its relationship with clinic. Results: the incidence of sensory abnormalities in the clavicular region was 19.25% (26 / 135). 16.3% (22 / 135) of them were numb and 2.8% (4 / 135) were pain. The most significant time of numbness was one month after operation. 0.7% (n = 1 / 135) had the most severe numbness, and 0.7% (n = 1 / 135) had moderate numbness and 14% (n / 20 / 135) had mild numbness. Among the cases with the most significant numbness, 2 cases had increased anaesthesia when exposed to clothes and other foreign bodies, and 2 cases were affected psychologically by the feeling of numbness. The rest of the cases were not confused by numbness in the clavicular region. 1.4% of the cases were mild pain, 0.7% moderate pain and 0.7% moderate pain. 98.6% (n 133 / 135) cases with the passage of time, Anaesthesia can be completely relieved, and 1.4% of the cases still have permanent numbness, but the cases are not confused by numbness. The autopsies showed that the supraclavicular nerve originated from the cervical plexus from the posterior edge of the sternocleidomastoid muscle, that is, three internal and external branches, located between the deep and superficial fascia, crossed the clavicle to the distal end and dominated the sensation around the clavicle. The projection of the three branches of the supraclavicular nerve was approximately the midpoint of the posterior edge of the sternocleidomastoid muscle to the lateral sternum stalk, the midpoint of the clavicle and the three leads of the shoulder peak. The results show that there are three branches of the supraclavicular nerve, the lateral branch is about 2.26 cm near the lateral edge of the acromial peak, the middle branch is close to the midclavicular point, and the medial branch is about 2.03cm outside the lateral margin of the sternosterium. Conclusion: this report shows the cases of supraclavicular nerve injury and skin hyposensory or allergic pain after clavicular fracture internal fixation. Most cases of postoperative numbness improved over time. The incidence of skin sensory loss is small, numbness patients, in the middle and late stage also have a greater degree of improvement. But a small number of patients with numbness can last 2 years, some even permanent numbness. Some of the patients in this report are affected by numbness, and all patients deny that numbness affects daily life in order to feel abnormal symptoms and other discomfort. The injury of supraclavicular nerve may be involved in open reduction and internal fixation of clavicle fracture and removal of plate. Operation should pay attention to separation, protection, as far as possible to avoid damage to this nerve.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3;R322.7

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