人工全髋关节置换术中坐骨神经损伤的应用解剖学研究

Study of Applied Anatomy on Total Hip Replacement and the Sciatic Nerve Injury

目的 通过解剖位置的分析探讨全髋置换 (THR)术中坐骨神经 (SN)损伤的因素。方法 本组共 5 6具成年骨盆标本 ,对SN的来源及走行、SN与髋臼的关系进行测量分析 ,并对在THR术中拉钩及螺丝钉固定所致SN损伤 ,进行详尽测量分析。结果 测出SN至髋臼底的距离左侧为 6± 0 85mm ,右侧为 6± 0 71 2 5mm ;SN至髋臼缘的距离左侧为 1 3± 0 75mm ,右侧为 1 4± 0 0 6 2 5mm。SN在髋臼缘处周径左侧为 32± 0 2 75mm ,右侧为 31± 0 6 75mm。髋臼底至坐骨大孔的距离为左侧为 2 9± 0 36 2 5mm ,右侧为 2 9± 0 2 375mm。并确定拉钩及螺丝钉固定在 1～ 3点及 5～ 6点为安全区。结论 在THR术中陈旧髋臼骨折脱位、拉钩的位置不当、螺钉固定髋臼位置不当均可以损伤SN。

Objective To analyse and explore for total hip replacement and the sciatic nerve injury on anatomic study.Methods Fifty six adult pelvic specimens fixed with formalin,measured and analyzed to sciatic nerve root、route and relation of sciatic nerve with acetabular.And sciatic nerve injuried by hand fingers of the persons or screw on total hip replacement was measured and analyzed.Results The left'sdistance from sciatic nerve to the bottom of acetabular was 6±0.85mm,right's 6±0 7125 mm; the left's distance from sciatic nerve to the edge of acetabular was 13±0 75 mm,right's 14±0 0625 mm.The left'sgirth of the sciatic nerve was 32±0 275 mm,right's 31±0 775 mm at the edge of acetabular.The left's distance from the bottom of acrtabular to greater sciatic hole was 29±0 3625 mm,right's 29±0 2375 mm.The safe area of hand fingers of the persons or screw was defined at 1～3 dot and 5～6 dot.Conclusion The injury of sciatic nerve on total hip replacement usually results from by old acetabular fracture dislocation or unsuitable position of hand fingers of the persons or screw.