| Objective:At present,there is still a certain rate of nonunion in open reduction and internal fixation of clavicle fracture.The purpose of this study is to further explore the impact of supraclavicular nerve protection on the long-term prognosis and fracture healing of patients,and further analyze the causes.Methods:In this study,a prospective study was used to select 83 patients with clavicle fracture in Baoding first Central Hospital from June 2021 to December 2022,including 57 males and 26 females,aged 18-72 years.The patients were randomly divided into two groups: the experimental group(protecting the supraclavicular nerve during operation)and the control group(not protecting the supraclavicular nerve during operation).The patients in the experimental group were treated with a surgical incision parallel to the long axis of the clavicle,carefully dissociated from the supraclavicular nerve during the operation,and continuously protected during the follow-up operation.Patients in the control group: use the same surgical incision as the experimental group,choose the traditional operation,and do not protect the supraclavicular nerve during the operation.After operation,the length of incision,operation time,intraoperative blood loss and hospitalization days of each patient were recorded,and the patients were followed up regularly by telephone follow-up or outpatient follow-up to assist patients to complete the questionnaire.Record the indicators.Observe the clinical effects of all aspects of the two groups of patients after operation,so as to compare whether there are differences in clinical effects between the two groups,and then come to the conclusion that that kind of operation has a better clinical effect on patients.Results:1.The basic data such as sex,age and injury mechanism of the two groups were comparable(P > 0.05).The intraoperative time of the two groups was longer than that of the control group(P < 0.05).There was no significant difference in the amount of intraoperative bleeding between the two groups(P > 0.05),but the hospitalization time of the two groups was basically the same(P > 0.05).2.The VAS scores of the two groups at 3 and 6 months after operation in the experimental group were lower than those in the control group.3.The fracture healing rate of the experimental group was better than that of the control group at 3 and 6 months after operation(P < 0.05),but there was no significant difference between the two groups at 12 months after operation(P > 0.05).However,all the patients in the experimental group healed,but there was still 1 case of nonunion in the control group.4.6 weeks after operation,bilateral shoulder angiography in the experimental group showed that the number of microvessels in the middle part of the clavicle of the affected side was basically the same as that of the healthy side(P > 0.05).Conclusions:1.Careful separation and protection of supraclavicular nerve during operation is beneficial to reduce postoperative pain and help patients to participate in early functional exercise more actively.2.Protecting supraclavicular nerve during operation is beneficial to promote fracture healing in patients with clavicular fracture,and there is a positive correlation between intraoperative protection of supraclavicular nerve and postoperative fracture healing rate,especially to improve the early fracture healing rate.3.Shoulder radiography at 6 weeks after operation shows that the protection of supraclavicular nerve during operation can not only achieve strong internal fixation,but also achieve less damage of blood supply at the end of fracture,which is beneficial to the reconstruction of postoperative microvascular network and achieve almost the same blood flow as conservative treatment. |
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