基于人工全髋关节置换术中坐骨神经损伤的应用解剖学研究

Applied Anatomy Research of Sciatic Nerve Injury in Total Hip Arthroplasty

目的进行全髋关节置换术的时候,其中的坐骨神经会出现一定程度损伤,本文通过分析解剖位置来探讨造成损伤的因素。方法此次研究使用骨盆标本来进行,这些标本总共有67具且都是成年的骨盆,测量分析髋臼和SN之间的关系以及SN的走行和来源,同时仔细的分析在THR手术中螺丝钉和拉钩固定所导致的SN损伤。结果最终测量出SN到臼底之间距离的右侧和左侧分别为(6±0.6014)mm和(6±0.74)mm。髋臼缘到SN之间的距离右侧是(14±0.0514)mm左侧是(13±0.64)mm。在髋臼缘处SN周径的左侧和右侧分别是(32±0.164)mm和(31±0.564)mm。坐骨大孔到髋臼底之间的距离也分为左侧和右侧,两侧的具体距离是(29±0.2514)mm和(29±0.1264)mm。并将螺丝钉和拉钩进行固定,要保证固定在5到6点和1到3点为安全区。结论拉钩的实际位置存在不当和陈旧髋臼出现脱落以及骨折,还有固定髋臼的时候使用螺丝钉的位置不准确,这些情况在THR的手术中都十分有可以能对SN造成严重损伤。

Objective during total hip replacement,sciatic nerve may be damaged to some extent.The paper analyzes anatomic location and explores causes of injury.Methods choose 67 cases adult pelvis specimens in the study,analyze and test relationship between acetabulum and SN and its trend and source,and analyze SN damage caused by screw and hook fixation during THR operation carefully.Results measure showed,distance between SN and joint base was(6±0.6014)mm on right and(6±0.74)mm on left.Distance from acetabulum edge to SN was(14±0.0514)mm on the right and(13±0.64)mm on the left.At acetabulum edge,SN circumference was(32±0.164)mm on the left and(31±0.564)mm on the right.Distance between foramen ischiatus and acetabulum base is(29±0.2514)mm on the left and(29±0.1264)mm on the right.Fixing screw and pull hook should ensure safety area of 5 to 6 clock and 1 to 3 clock.Conclusion improper actual position of retractor,fall off and fracture of old acetabulum,and not accurate position of screw duirng acetabulum fix,may cause serious damage to SN in THR operation.