Department of Orthopaedic Surgery, Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
Department of Orthopaedic Surgery, Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital and Australian National University Medical School, Building 6, Level 1, Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
Injury. 2021 Mar;52(3):501-505. doi: 10.1016/j.injury.2020.10.100. Epub 2020 Oct 27.
Supraclavicular nerve injury is one of the common complications after clavicle open reduction internal fixation (ORIF) affecting up to 55% of patients. There is debate about whether sparing supraclavicular nerves improves functional outcomes and patient satisfaction. The purpose of this study was to compare numbness, patient-reported outcomes and surgical time in patients undergoing clavicle ORIF using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques.
We conducted a retrospective cohort study with prospective survey of 108 patients with clavicular fractures treated with ORIF at a level 1 trauma centre. Patients were divided into two groups: 1) ORIF with supraclavicular nerve sparing techniques and 2) ORIF with supraclavicular nerve sacrificing techniques. Questionnaires were conducted and subjective numbness around supraclavicular nerve distribution was our primary outcome measure. Secondary outcome measures included the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, a numeric rating scale for pain and satisfaction with treatment and surgical time.
An overall response rate of 92% was achieved with an average follow-up of 16 months. There were 20 patients in the supraclavicular nerve sparing group and 79 patients in the supraclavicular nerve sacrificing group. 76% of all patients experienced numbness post-operatively and 91% of these patients experienced persistent numbness at final follow-up. There was no significant difference between the groups for age, gender, time to follow-up and mechanism of injury. Patients in the supraclavicular nerve sparing group had significantly less numbness at final follow-up (35% vs 86%, P < 0.001; OR=0.21 95%CI 0.11-0.40). There was no significant difference in the QuickDASH score nor the NRS for pain and function. Sparing supraclavicular nerves did not result in a significantly longer operation.
Our study demonstrates that identification and protection of the supraclavicular nerves result in significantly less numbness following clavicle ORIF but does not affect patient reported functional outcomes.
锁骨开放性复位内固定（ORIF）术后，锁骨上神经损伤是常见并发症之一，高达 55%的患者会发生这种并发症。关于保留锁骨上神经是否能改善功能结果和患者满意度存在争议。本研究的目的是比较采用锁骨上神经保留和牺牲技术行锁骨 ORIF 的患者的麻木感、患者报告的结果和手术时间。
我们对一家一级创伤中心的 108 例锁骨骨折患者进行了回顾性队列研究，并前瞻性地进行了调查。患者分为两组：1）锁骨上神经保留技术行 ORIF；2）锁骨上神经牺牲技术行 ORIF。我们进行了问卷调查，锁骨上神经分布区域的主观麻木感是我们的主要观察指标。次要观察指标包括上肢、肩和手的快速残疾（QuickDASH）评分、疼痛的数字评分量表和对治疗及手术时间的满意度。
总应答率为 92%，平均随访 16 个月。锁骨上神经保留组有 20 例患者，锁骨上神经牺牲组有 79 例患者。所有患者中有 76%术后出现麻木感，其中 91%的患者在最终随访时仍有持续性麻木感。两组患者在年龄、性别、随访时间和损伤机制方面无显著差异。锁骨上神经保留组患者在最终随访时麻木感明显较轻（35%比 86%，P<0.001；OR=0.21，95%CI 0.11-0.40）。QuickDASH 评分和疼痛及功能的 NRS 无显著差异。保留锁骨上神经并未导致手术时间显著延长。
我们的研究表明，识别和保护锁骨上神经可使锁骨 ORIF 后麻木感明显减轻，但不会影响患者报告的功能结果。
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