髋臼后壁骨折伴髋关节后脱位与坐骨神经损伤的临床分析

Clinical Analysis of Injuries of Sciatic Nerve Associated with Acetabular Posterior Wall Fracture and Dislocation

目的探讨髋臼后壁骨折伴髋关节后脱位合并坐骨神经损伤的创伤机制、类型和预后关系。方法笔者收治髋臼后壁骨折伴髋关节后脱位合并坐骨神经损伤21例,在骨折内固定时,均行坐骨神经探查术,按MCRR标准评定神经功能恢复情况。结果21例在术后24个月内,神经均有不同程度的功能恢复,优11例,良9例,可1例,优良率为95.2%。本组无一例出现医源性损伤。结论髋臼后壁骨折伴髋关节后脱位常合并坐骨神经损伤者,在骨折内固定时应探查神经,结合损伤性质和程度,采取相应治疗措施,有利于正确判断预后和恢复神经功能。

Objective To investigate the relationship between the mechanism of injuries, type, and prognosis of sciatic nerve associated with acetabular posterior wall fracture and dislocation. Methods The nerve exploration and neurolysis of sciatic nerve were performed as well as open reduction and internal fixation on 21 patients hospitalized with injuries of sciatic nerve associated with acetabular posterior wall fracture and dislocation. The functional recovery of sciatic nerve was assessed according to the MCRR＇ s standard. Results Of 21 patients who had the different degree recovery of nerve function, 11 were excellent, 9 good, 1 fair according to the standard. No iatrogenic injury of the sciatic nerve was found in these patients. Conclusion The nerve exploration and neurolysis should be performed based on clinical examination together with the character and severity of injuries of nerve in operation of the acetabular posterior wall fracture and dislocation, which favors the recovery of nerve function and estimates the prognosis of nerve injuries correctly.