锁骨上神经在锁骨上区域分布的解剖观察

目的 探讨锁骨上神经在锁骨上区域的分布规律,为临床手术提供参考。方法 前瞻性研究。纳入2017年9 月—2018 年12月保定市第一中心医院西院骨五科在骨折复位内固定手术中同时完成锁骨上神经解剖的锁骨骨折患者30例(30侧),其中男16例、女14例,年龄18 ～ 46 岁。30 例手术均取锁骨上切口,术中仔细分离出锁骨上神经各个分支,统计每例的神经分支数目,并了解其在锁骨上区域的走行及分布关系。以锁骨两端中点连线为锁骨横轴,在C形臂X线机透视下,术中用克氏针标记锁骨上神经各分支横跨锁骨上缘处;将锁骨横轴全长视为单位“1”,以锁骨横轴内侧端为 “0”点、外侧端为 “1”点,在X线影像上测量锁骨上神经各分支标记点到“0”点的距离,进而比较分支数目不同时,其内、外分支分布具体位置的差异。结果 30例锁骨区域解剖显示,有 15例锁骨上神经拥有三支分支(内、中、外支),14例拥有两支分支(内、外支),1例拥有一支分支(中支)。利用相对测量方法测量出15例有三支分支患者解剖观察结果示外侧支出现于0.64±0.081、中间支出现于0.47±0.12、内侧支出现于0.27±0.08 ;14例有两支分支患者解剖观察结果示外侧支出现于0.61±0.07、内侧支出现于0.30±0.07;一支分支患者解剖观察结果示中间支出现于0.57。统计学分析显示,不同分支数目患者间内、外支神经分支分布区域差异均无统计学意义(P值均＞0.05)。结论 锁骨上神经在锁骨上区域出现的部位具有一定规律,掌握这一规律可为术中避免损伤锁骨上神经及二期钢板取出提供一定的帮助。

Anatomical study on the distribution of supraclavicular nerve in the supraclavicular region

Objective To study the distribution of supraclavicular nerve in supraclavicular region and provide reference for operation.Methods Prospective study. From September 2017 to December 2018, 30 patients with clavicle fractures, including 16 males and 14 females, aged from 18 to 46 years old, had completed the anatomy of the supraclavicular nerve in the Surgery of Fracture Reduction and Internal fixation in the Fifth Department of Orthopaedic, the First Central Hospital of Baoding City. The supraclavicular incisions were taken in all the 30 patients(30 sides), and the branches of the supraclavicular nerves were carefully separated during the operation.The number of nerve branches in each patient was counted and its course and distribution in the supraclavicular region was studied. The branches of the supraclavicular nerve were marked by kirs needle across the supraclavicular border. The midpoint line at both ends of the clavicle was used as the collarbone transverse axis. Take the full length of the collarbone transverse axis as unit “1”. The medial end of the collarbone transverse axis was taken as “0” and the lateral end as“1”.C arm X-ray machine were used to measure the distance from the mark point of each branch of the supraclavicular nerve to the point of “1”, and then the differences in the specific locations of the distribution of internal and external branches with different branch numbers were compared.Results Regional anatomy of the clavicle showed that 15 patients had three supraclavicular nerve branches (internal, middle and external branches), 14 patients had two nerve branches (internal and external branches), and 1 patient had one nerve branch (middle branch). The anatomical observation results of 15 patients with three branches by relative measurement method showed that the lateral branch appeared in 0.64±0.081, the intermediate branch appeared in 0.47±0.12, and the medial branch appeared in 0.27±0.08. The anatomic observation results of 14 patients with two branches showed that the lateral branch appeared in 0.61±0.07 and the medial branch appeared in 0.30±0.07. Anatomical observation of one branch showed that the intermediate branch appeared in 0.57. There was no statistically significant difference in the distribution of the three nerve branches (all P values＞0.05).Conclusions The supraclavicular nerve has a regular distribution in the supraclavicular region. This study provides a basis to avoid injury of supraclavicular nerve in the fixation surgery and the second stage plate removal surgery.