目的 比较C5神经根阻滞（C5-NRB）联合颈神经通路阻滞（CNPB）、C5-NRB联合颈浅丛神经阻滞（SCPB）、肌间沟臂丛神经阻滞（ISBPB）联合SCPB 3种超声引导下神经阻滞方案在锁骨骨折手术中的麻醉效果与安全性。 方法 本研究共纳入90例美国麻醉医师协会ASA分级Ⅰ—Ⅱ级，拟行择期锁骨骨折手术患者。采用随机数字表法均分为3组（每组30例）：C5C组（接受C5-NRB联合CNPB）、C5S组（接受C5-NRB联合SCPB）、IS组（接受ISBPB联合SCPB）。给药方案如下：C5C组接受超声引导下C5神经根注射0.4%罗哌卡因5 mL，随后行CNPB注射0.4%罗哌卡因10 mL；C5S组行C5-NRB联合10 mL 0.4%罗哌卡因的SCPB；IS组则接受ISBPB与SCPB，两处各注入0.4%罗哌卡因10 mL。阻滞操作实施后，利用针刺法验证锁骨区域皮肤的感觉阻滞范围并记录疼痛强度。主要监测指标包括感觉阻滞起效时间、术中舒芬太尼用量及术毕、术后6、12 h对患者上肢运动功能评估的改良Bromage评分（屈肘、屈腕、屈指）；次要指标包括术中深呼吸状态下膈肌位移、血压变化及系统记录局麻药中毒、星状神经节阻滞、喉返神经阻滞、膈神经麻痹和穿刺痛等不良事件发生情况。 结果 数据显示，C5C组阻滞起效时间显著短于C5S组和IS组（P < 0.05）；在术中镇痛药物需求方面，C5C组的舒芬太尼用量显著低于C5S组（P < 0.05），但与IS组相比差异无统计学意义。就运动功能保留而言，术毕及术后6、12 h，C5C组与C5S组在患侧上肢屈肘、屈腕及屈指功能的改良MBS评分上均显著优于IS 组（P < 0.05）。值得注意的是，C5C组与C5S组的膈神经阻滞发生率显著低于IS组（P < 0.05）。 结论 超声引导下C5-NRB联合CNPB为锁骨骨折手术提供了一种理想的区域麻醉方案。该方案不仅具备起效迅速、镇痛完善及运动功能保留良好等优势，更显著降低了膈神经阻滞的发生风险，展现出卓越的临床效能与安全特性。

Objective To evaluate and compare the anesthetic efficacy and safety profiles of three ultrasound-guided nerve block regimens for clavicle fracture surgery： C5 nerve root block （C5-NRB） combined with cervical nerve pathway block （CNPB）， C5 nerve root block paired with superficial cervical plexus block （SCPB）， and interscalene brachial plexus block （ISBPB） combined with SCPB. Methods By using a random number table， 90 patients scheduled for clavicle fracture surgery （ASA Ⅰ-Ⅱ） were randomly allocated to three groups （30 patients per group）： the C5C group （C5-NRB combined with CNPB）， the C5S group （C5-NRB paired with SCPB）， and the IS group （ISBPB coupled with SCPB）. All nerve blocks were performed under ultrasound guidance with 0.4% ropivacaine. In the C5C group， 5 mL of the anesthetic was injected at the C5 nerve root， followed by 10 mL within the cervical nerve pathway. The C5S group underwent a C5 nerve root block plus a superficial cervical plexus block （10 mL）. In contrast， the IS group received 10 mL each for the interscalene brachial plexus block and the superficial cervical plexus block. After the nerve block was completed， the cutaneous sensory level over the clavicular surgical field was verified using the pinprick technique， and the pain intensity was documented simultaneously. Both the onset time of the sensory block and the intraoperative requirements of sufentanil were recorded. The Modified Bromage Score （MBS） was used to assess the motor function of the affected-side upper limb at the end of surgery and at 6 and 12 hours postoperatively. Diaphragmatic excursion alterations during deep breathing and changes in blood pressure were monitored during the operation. The occurrence of adverse events， including local anesthetic toxicity， stellate ganglion block， recurrent laryngeal nerve involvement， ipsilateral phrenic nerve paralysis， and puncture pain， was systematically recorded throughout the perioperative period. Results The onset of block in the C5C group was significantly faster than that in the C5S and IS groups （P < 0.05）. The intraoperative sufentanil requirements in the C5C group were significantly lower compared to those in the C5S group （P < 0.05）， but there was no statistically significant difference compared to the IS group. Regarding the preservation of motor function， significantly higher MBS scores were recorded at 6 and 12 hours after surgery in the C5C and C5S groups than in the IS group （P < 0.05）. Moreover， the incidence of phrenic nerve block was markedly reduced in both the C5C and C5S groups compared with the IS group （P < 0.05）. Conclusions The combination of ultrasound-guided C5 nerve root block and cervical nerve pathway block offers a regional anesthetic approach with a rapid onset， analgesic effectiveness， and motor sparing for clavicle fracture surgery. Moreover， it significantly reduces the risk of phrenic nerve block. This technique exhibits superior clinical efficacy and safety.