| 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):1-6,10 |
| 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 |
| Importance of Supraclavicular Nerve Protection during Internal Fixation of Clavicular Fracture: A Systematic Review and Meta-analysis |
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| 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: |
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| 摘要点击次数: 333 |
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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对锁骨骨折患者术后影响的科学证据，明确保护锁骨上神经的重要性。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、PubMed、Web of Science、CINAHL和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分析评估术中保护锁骨上神经对锁骨骨折患者的影响。结果：共有13篇文献，915例锁骨骨折患者纳入研究。通过Meta分析发现：游离保护锁骨上神经术后患者出现神经损伤的比例、术后3个月皮肤麻木面积、疼痛评分、麻木影响生活的患者比例及其他并发症比例明显比切断组小，而上肢功能评分、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；但两组在手术时间、失血量、骨折愈合时间及住院时间上无统计学差异。结论：锁骨骨折切开复位内固定时，游离保护锁骨上神经可明显降低锁骨上神经损伤发生率，减轻患者术后疼痛，缩小局部皮肤麻木面积，提高术后上肢功能，且能降低患者术后伤口感染、红肿、发热和胸膜损伤等并发症发生率。此外，术中游离保护锁骨上神经不会增加手术时间、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 supraclavicular nerve (SN) protection on patients with clavicular fracture (CF), and to clarify the importance of SN protection. Methods: Chinese and english electronic databases (CNKI, Wanfang, Chinese biomedical literature database, VIP chinese database, PubMed, Web of Science, CINAHL and EMBASE english database) were used to search the relevant literatures, and screened clinical control studies. 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, skin numbness area 3 months after operation, the 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 lower than those in patients with SN transection, while Constant-Murley score evaluating for upper limb function, the proportion of no numbness of skin 3 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, free protection of SN can significantly reduce the rate of SN injury , postoperative pain and local skin numbness area, improve the upper limb function after operation, and reduce the incidence of complications including wound infection, redness, fever and pleural injury for CF patients. In addition, intraoperative free 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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