文章摘要
王海平,肖春田.锁骨骨折内固定术中保护锁骨上神经的重要性:系统评价和Meta分析[J].实用中西医结合临床,2021,21(10):
锁骨骨折内固定术中保护锁骨上神经的重要性:系统评价和Meta分析
Effect of supraclavicular nerve protection on the patients suffering from clavicular fracture: A systematic review and meta-analysis
投稿时间:2021-02-26  修订日期:2021-05-13
DOI:
中文关键词: 锁骨骨折,锁骨上神经,内固定,神经保护,Meta分析。
英文关键词: clavicular  fracture, supraclavicular  nerve, internal  fixation, neuroprotection, meta-analysis.
基金项目:
作者单位E-mail
王海平 广东省韶关市曲江区人民医院骨科 616747480@qq.com 
肖春田 广东省韶关市曲江区人民医院骨科  
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中文摘要:
      目的:本研究系统地回顾和量化术中保护锁骨上神经(supraclavicular nerve, SN)对锁骨骨折(Clavicle Fractures, CF)患者术后影响的科学证据,明确保护SN的重要性。方法:在中英文电子数据库(CNKI、万方、中国生物医学文献数据库、维普中文数据库和Pubmed、Web of science、CINAHL、Embase英文数据库)中进行相关文献的检索,筛选临床对照研究,采用Meta分析评估术中保护SN对CF患者的影响。结果:共有13篇文献,共有915名CF患者纳入本研研究。通过Meta分析发现:游离保护SN术后患者出现神经损伤的比例、术后3个月皮肤麻木面积、疼痛VAS评分、麻木影响生活的患者比例及其它并发症比例明显比切断组小,而上肢功能Constant-Murley评分、术后3个月皮肤无麻木比例、手术优良率及手术切口长度比切断组大;但在手术时间、失血量、骨折愈合时间及住院时间上两组的差异也没有统计学差异。结论:进行CF切开复位内固定时,游离保护SN可明显降低SN的损伤发生率,减轻患者术后疼痛和局部皮肤麻木面积,提高CF患者术后上肢功能;且能降低术后患者伤口感染、红肿、发热和胸膜损伤方面的并发症。此外,术中游离保护SN不会增加对手术时间、失血量、骨折愈合时间及住院天数,但会增大手术切口长度。
英文摘要:
      Objective: To systematically review and quantify the scientific evidence of the effect of intraoperative protection of supraclavicular nerve (SN) on patients with clavicle fractures (CF), and to clarify the importance of SN protection. Methods: Chinese and English electronic databases (CNKI, Wanfang, Chinese biomedical literature database, VIP Chinese database and PubMed, web of science, CINAHL, EMBASE English database) were used to search the relevant literature, and clinical randomized controlled studies were screened one by one. The impact of intraoperative Sn protection on CF patients was evaluated by meta-analysis. Results: a total of 13 studies with 915 CF patients were included in this study. Through meta-analysis, we found that: the proportion of nerve injury, numbness area, VAS score of pain, the proportion of patients with numbness affecting life and other complications in patients with free protection SN after operation were significantly smaller than those in patients with SN transection, while Constant-Murley score evaluating for upper limb function, the proportion of no numbness of skin in three months after operation, the excellent rate of operation and the length of incision were larger than those in patients with SN transection; but There was no significant difference in operation time, blood loss, fracture healing time and hospitalization time between the two groups. Conclusion: For open reduction and internal fixation of CF, preservation of SN can significantly reduce the injury rate of SN, reduce postoperative pain and local skin numbness area, improve the upper limb function for CF patients, and reduce the complications including wound infection, redness, fever and pleural injury. In addition, intraoperative SN protection will not increase the operation time, blood loss, fracture healing time and hospitalization days, but will increase the length of surgical incision.
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