锁骨骨折手术内固定术后锁骨区感觉异常的临床及解剖学观察（附135例临床观察）
发布时间：2019-03-03 14:00
【摘要】：目的:观察锁骨骨折切开复位内固定术后锁骨区感觉异常的临床及解剖学结果。方法:回顾性分析2013年5月至2016年6月期间在广西医科大学第一附属医院及广西医科大学第二附属医院进行锁骨骨折切开复位内固定术的135例病例资料,根据患者术后锁骨区域感觉异常的临床症状,麻木较显著的时间,触碰到其他物体时麻木情况,锁骨术区疤痕疼痛及取出钢板后对麻木症状的改变,随访上述事件。在解剖教研室对7具正常人尸体(男性6具、女性1具)进行锁骨上神经解剖,了解锁骨上神经走向、分支及其与临床关系。结果:术后锁骨区感觉异常的发生率19.25%(n=26/135)。其中16.3%(n=22/135)为麻木,2.8%(n=4/135)为疼痛。其中麻木最显著的时间为术后一个月。0.7%(n=1/135)患者诉麻木程度最为严重,同时0.7%(n=1/135)的患者为中度麻木及14%(n=20/135)则为轻度麻木。麻木症状最显著的病例中,有2例在接触衣服及其他异物时麻木感增加,有2例因麻木感而心理受到影响。本组其余病例未因锁骨区麻木而感到困惑。1.4%病例为轻度疼痛,0.7%位中度疼痛及0.7%为中度疼痛。98.6%(n133/135)病例随着时间的推移,麻木感可完全缓解,仍有1.4%病例出现永久性麻木,但其中病例没有因麻木而感到心里困惑。尸体解剖显示,锁骨上神经自颈丛从胸锁乳突肌后缘中下1/2处发出,即分出内中外三支,位于深浅筋膜之间,向远端越过锁骨,支配锁骨周围感觉。锁骨上神经的三支体表投影大致为胸锁乳突肌后缘中点分别至胸骨柄外侧、锁骨中点及肩峰的三条引线。本报告结果显示锁骨上神经的三个分支,外侧支在肩峰外侧缘近端约2.26cm、中间支接近锁骨中点、内侧支在胸骨柄外侧缘外侧约2.03cm。结论:本报告显示锁骨骨折内固定术后锁骨上神经损伤及其皮肤感觉减退或过敏性疼痛的病例。大部分术后出现麻木的病例随着时间的推移而改善。皮肤感觉减退发生率较小,有麻木的患者,中后期也有较大程度的改善。但有少部分患者麻木可持续2年,有的甚至是永久性的麻木。本报告中部分患者因麻木而影响,特意到门诊为了感觉异常症状等不适就诊,所有患者均否认麻木影响到日常生活。在锁骨骨折切开复位内固定术及钢板取出术中,可涉及锁骨上神经的损害。术中操作应注意分离、保护,尽量避免损伤此神经。
[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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R322.7
本文编号：2433760
[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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R322.7
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