骨科速读 | 锁骨骨折术中是否有必要保留锁骨上神经？（配图很好）

“在锁骨骨折手术中,不总是需要保留锁骨上神经。然而,保留它也有一定的好处。”

（一）锁骨上神经的分布模式

上图展示了锁骨上神经的典型模式。

下图引自论文The Anatomy of the Supraclavicular Nerve During Surgical Approach to the Clavicular Shaft，文章解剖了37个标本，发现97%的标本具有锁骨上神经的内侧分支和外侧分支。近一半（49%）拥有额外的中间分支。胸锁关节 2.7 cm 内或肩锁关节 1.9 cm 内未发现分支（安全区）。在这两个位置之间，神经分支位置存在很大差异。具体变异位置见下图所示。

（二）锁骨上神经支配的区域

锁骨上神经是一条表浅的感觉神经,它横跨锁骨,支配锁骨前部、肩部前内侧和胸部上方的感觉。见上图中supraclavicular nn.指向的区域。

（三）如何考虑评估是否保留？

首先，我们要知道，锁骨上神经损伤不都是医源性的，也有部分高能量损伤、骨折端移位的锁骨干骨折也会损伤锁骨上神经分支。术前应查体以明确。

如果在手术中损伤锁骨上神经,可能会导致相关部位的麻木。这种麻木可能是暂时的或永久的,程度从轻到重不等。通常这是一种可以忍受的并发症，特别是在术前告知到位的情况下。但也有一部分病人不能忍受。

在某些特殊情况下,保留锁骨上神经对患者的生活质量可能很重要。例如，如果患者是运动员或音乐家,他们可能依靠这些部位的感觉来进行活动。

然而,强行保留锁骨上神经也存在一定的风险。例如,如果在手术中拉伸或压迫神经,可能会导致疼痛和刺痛。此外,如果损伤神经,可能导致神经瘤的发展,神经瘤是一种疼痛性的神经组织生长。

总的来说,在锁骨骨折手术中是否保留锁骨上神经是一个复杂的决定,应逐案决定。医生需要考虑患者的个人情况和偏好来做出这个决定。医生在做出这个决定时可能考虑的因素包括:患者的年龄和整体健康状况、骨折的严重程度、患者的职业或爱好、患者的康复期望。

如果医生决定保留锁骨上神经,要在手术中采取措施来保护神经。如前文所属和图示，胸锁关节 2.7 cm 和肩锁关节 1.9 cm 内是两个安全区。在两个安全区域之间，神经分支的位置是变动的，如果外科医生希望防止横断神经，则术中必须细致解剖。有条件的可以使用神经刺激器来定位神经,并避免在神经附近放置任何缝合线或植入物。纵行小切口（MIPO技术 ）也有利于保护神经。

---英语角 ：以下内容来自AI ，仅供参考---

The supraclavicular nerve is a superficial sensory nerve that crosses the clavicle and provides sensation over the clavicle, anteromedial shoulder, and proximal chest. It is a branch of the cervical plexus, which is a network of nerves that originates from the C3 and C4 nerve roots.

During surgical approach to the clavicular shaft, the supraclavicular nerve is at risk of injury. This is because the nerve is located in the area where the surgeon needs to make an incision to access the clavicle.

To help prevent injury to the supraclavicular nerve, surgeons may use a nerve stimulator to identify the nerve during surgery. This allows the surgeon to see where the nerve is located and avoid injuring it.

In addition, surgeons may use a technique called 'nerve sparing' to protect the supraclavicular nerve. This involves making an incision that avoids the nerve and then using a flap of tissue to cover the nerve during surgery.

If the supraclavicular nerve is injured during surgery, it can cause numbness in the area that the nerve supplies. This numbness can be temporary or permanent, and it can range from mild to severe.

In some cases, the numbness may improve over time. However, in other cases, the numbness may be permanent.

To help prevent injury to the supraclavicular nerve, it is important to discuss this risk with your surgeon before surgery. You should also ask your surgeon about the steps they will take to protect the nerve during surgery.

Here are some additional things to keep in mind about the supraclavicular nerve during surgical approach to the clavicular shaft:

• The nerve is typically located within 2.7 cm of the sternoclavicular joint and 1.9 cm of the acromioclavicular joint.

• There are three branches of the supraclavicular nerve: medial, intermediate, and lateral.

• The medial branch supplies sensation to the medial side of the clavicle and the anteromedial shoulder.

• The intermediate branch supplies sensation to the proximal chest.

• The lateral branch supplies sensation to the lateral side of the clavicle.

If you have any questions or concerns about the supraclavicular nerve, be sure to talk to your surgeon.