髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析

Clinical analysis of acetabular fracture and hip dislocation complicated with sciatic nerve injuries

目的探讨髋臼骨折、髋关节脱位合并坐骨神经损伤的临床特点及发病机制。方法回顾髋臼骨折、髋关节脱位及髋臼骨折合并髋关节脱位的患者155例(159侧),其中合并坐骨神经损伤35侧。分析髋臼骨折、髋关节脱位的流行病学特点及坐骨神经损伤与髋臼骨折、髋关节脱位分型的关系。结果81.3%的患者为男性,86.5%的患者年龄为20～50岁,83.9%为车祸伤所致。坐骨神经损伤总发病率为22.01%,而在髋臼骨折为17.19%,在单纯髋关节后脱位为12.90%,在髋臼骨折合并髋关节后脱位为36.36%。31侧坐骨神经损伤中48.39%为腓总神经成分损伤,51.61%为腓总神经+胫神经损伤。结论车祸伤是髋臼骨折、髋关节脱位的主要原因,多见于成年男性。坐骨神经损伤主要发生于髋臼后壁、后柱骨折合并髋关节后脱位患者,且腓总神经成分损伤多见。

Objective To investigate the clinical characteristics and the causative mechanism of acetabular fracture and dislocation of hip complicated with sciatic nerve injuries. Methods A retrospective analysis was done for 155 cases (159 sides) of acetabular fracture, dislocation of hip, or acetabular fracture combined with hip dislocation, 35 of which were complicated with sciatic nerve injuries. The epidemiological features of acetabular fracture and hip dislocation, the incidence, and relationship between sciatic nerve injury and classifications of acetabular fracture and dislocation of hip were analyzed. Results 81.3%of the patients were male. The ages of 86.5%of the patients ranged from 20 to 50 years old. 83.9%of the cases were injured in traffic accidents. The incidence of sciatic nerve injury was 22.01%in all the patients, 17.19%in patients with acetabular fracture, 12.90%in patients with posterior wall, and 36.36%in patients with acetabular fracture combined with posterior dislocation of hip. Conclusions A road traffic accident is the major causative factor for acetabular fracture and dislocation of hip. Most victims are male. Sciatic nerve injuries largely happen in cases of acetabular posterior wall fracture and posterior column fractures combined with posterior dislocation of hip. Peroneal nerve injuries are the most common type of sciatic nerve injury.