Preservation versus Sacrifice of the Supraclavicular Nerves during Clavicle ORIF: A Randomized Controlled Trial.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Indraneel S Brahme, Geneva Tranchida, Jeffrey D Winter, Gaonhia Y Moua, Patrick Horrigan, Brian Cunningham, Peter A Cole
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引用次数: 0

Abstract

Objectives: To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures.

Methods: Design: Prospective, partially blinded randomized controlled trial.

Setting: Single academic Level I Trauma Center.

Patient selection criteria: Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a "nerve-sacrificing" or "nerve-sparing" group.

Outcome measures and comparisons: Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation (SANE) scores and symptom severity level (SSL) providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between "nerve-sacrificing" and "nerve-sparing" groups were compared.

Results: 21 patients (median age 41.5, 28.6% female) were randomized to "nerve-sacrificed" and 16 (median age 45.6, 18.8% female) to the "nerve-spared" group. There were no statistical differences in age or gender ratio (p=0.304 and 0.702 respectively). Longitudinal models including an interaction between group and time, showed cohort differences being driven by 12-weeks (49.3 (95% CLM 7.68, 90.92)) and 24-weeks (23.92 (95%CLM 1.70, 46.14)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL data showed improvements in both cohorts over time, however; there were no statistically significant differences between the groups (p=0.176 and 0.155, respectively).

Conclusions: Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12- and 24-weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared to sacrificing the nerve.

Level of evidence: Level I, Therapeutic.

锁骨ORIF中锁骨上神经保留与牺牲:一项随机对照试验。
目的:探讨保留神经与牺牲神经在锁骨骨折ORIF手术后的症状差异。方法:设计:前瞻性、部分盲法随机对照试验。环境:单一学术一级创伤中心。患者选择标准:闭合性、孤立性、移位性锁骨中轴骨折(OTA/ ao15 - 2a, -2B, -2C)患者接受ORIF治疗,经同意并随机分为“神经牺牲”组或“神经保留”组。结果测量和比较:Semmes-Weinstein单丝法用于检测锁骨上区周围的感觉变化,单评估数值评估(SANE)评分和症状严重程度(SSL)提供患者自我报告的变化,并在随访时发放患者发病率问卷。一位训练有素的研究员测量并绘制了麻醉区域。“神经牺牲”组和“神经保留”组的结果比较。结果:21例患者(中位年龄41.5岁,女性28.6%)随机分为“神经牺牲”组,16例患者(中位年龄45.6岁,女性18.8%)随机分为“神经保留”组。年龄、性别比差异无统计学意义(p分别为0.304、0.702)。纵向模型包括组和时间之间的相互作用,显示队列差异由12周(49.3 (95%CLM 7.68, 90.92))和24周(23.92 (95%CLM 1.70, 46.14))驱动。虽然备用组在2周和52周时的积分估计值仍然较低,但两组之间没有显着差异。然而,随着时间的推移,两组的SANE评分和SSL数据都有所改善;两组间差异无统计学意义(p分别为0.176、0.155)。结论:锁骨骨折切开复位内固定术中保留锁骨上神经可显著减少术后12周和24周胸壁麻醉面积。然而,与牺牲神经相比,保留神经在其他症状上没有显著的临床差异。证据等级:一级,治疗性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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