Ko Sang-Hun, Kim Myung-Seo
Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Kyung Hee University Hospital At Gangdong, Seoul, Republic of Korea.
Arch Orthop Trauma Surg. 2022 Aug;142(8):1895-1902. doi: 10.1007/s00402-021-03941-w. Epub 2021 May 9.
Only a few previous studies have evaluated the factors related to supraclavicular nerve (SCN) injury after clavicle mid-shaft fracture surgery. We analyzed the frequency and risk factors for SCN injury after clavicle mid-shaft fracture surgery via open reduction and internal fixation (ORIF) versus minimally invasive plate osteosynthesis (MIPO) MATERIALS AND METHODS: We retrospectively reviewed the cases from 59 patients who had undergone surgery for clavicle mid-shaft fractures between January 2018 and April 2019. Twenty-nine patients had undergone ORIF and 30 had undergone MIPO. The frequency of SCN injury in the two groups was evaluated, and preoperative patient demographics (age, sex, body mass index, smoking, alcohol, diabetes mellitus, and trauma mechanism), and radiological parameters (fracture displacement and shortening) were measured and evaluated as risk factors for SCN injury. When neurological symptoms, such as numbness, were present on the anterior chest wall or at the incision site, electromyography (EMG) was conducted.
Neurological symptoms were present in 12 patients. Numbness in the anterior upper chest around the incision site was present in eight and four patients who underwent ORIF and MIPO, respectively (p < 0.001). Furthermore, fracture displacement evaluated on preoperative three-dimensional computed tomography was significantly associated with the occurrence of SCN injury in patients who underwent MIPO (odds ratio, 1.038; 95% confidence interval, 1.001-1.077; p = 0.047). Although EMG was conducted in all patients with SCN injury, peripheral neuropathy was not found in any cases.
SCN injury, which is a possible complication of clavicle mid-shaft fracture surgery, occurred significantly less frequently in MIPO than in ORIF. In MIPO, greater preoperative fracture displacement was associated with a higher risk of SCN injury. Additional studies are required to reach a consensus regarding accurate methods to evaluate SCN injuries.
IV, case series, treatment study.
以往仅有少数研究评估了锁骨中段骨折手术后与锁骨上神经（SCN）损伤相关的因素。我们通过切开复位内固定（ORIF）与微创钢板接骨术（MIPO）分析了锁骨中段骨折手术后SCN损伤的发生率及危险因素。
我们回顾性分析了2018年1月至2019年4月期间59例接受锁骨中段骨折手术患者的病例。29例患者接受了ORIF，30例接受了MIPO。评估两组中SCN损伤的发生率，并测量和评估术前患者人口统计学特征（年龄、性别、体重指数、吸烟、饮酒、糖尿病和创伤机制）以及放射学参数（骨折移位和缩短）作为SCN损伤的危险因素。当胸壁前部或切口部位出现麻木等神经症状时，进行肌电图（EMG）检查。
12例患者出现神经症状。接受ORIF和MIPO的患者中，分别有8例和4例在切口部位周围的前胸上部出现麻木（p<0.001）。此外，术前三维计算机断层扫描评估的骨折移位与接受MIPO患者的SCN损伤发生显著相关（优势比，1.038；95%置信区间，1.001 - 1.077；p = 0.047）。尽管对所有SCN损伤患者均进行了EMG检查，但未发现任何周围神经病变病例。
SCN损伤是锁骨中段骨折手术的一种可能并发症，MIPO中其发生率明显低于ORIF。在MIPO中，术前骨折移位越大，SCN损伤风险越高。需要进一步研究以就评估SCN损伤的准确方法达成共识。
IV，病例系列，治疗研究。
