取髂骨植骨术中腰丛及主要分支神经的外科管理

Surglcal management of lumbar plexus and their main branches in graftng procedures of harvesting iliac bone

目的为取髂骨植骨术中腰丛及其主要分支神经的外科管理提供参考。方法回顾性调查410例接受取髂骨植骨术患者的病历资料,记录取髂骨方式、大小、部位以及有无切断神经、术后神经损伤情况、治疗方法、效果等,并加以统计分析。采用综合方法对神经损伤进行诊断。结果环锯法、常规法、开窗法导致的神经损伤发生率分别为8.0%、23.1%、23.7%,差异有统计学意义(P<0.05);全部(22例)神经痛患者采用神经切除术获得治愈。结论对神经损伤的诊断应采取综合的方法;环锯法取髂骨导致的神经损伤发生率较其他两种方法低,神经切除术对神经痛的疗效较好。

Objective To offer information for surgical management of lumbar plexus and their main branches in harvesting iliac bone for bone grafting. Methods Investigated the clinical data of 410 cases of patients who received grafting procedures of harves- ting iliac bone,which was consisted of the way of bone harvest, size of the obtained iliac and it＇s location in the iliac, whether cut nerve or not, postoperative nerve injuries, treatment and effects. Then the data was analyzed. Results We used an integrated approach to the diagnosis of nerve injury. Separately , the incidence of nerve injury caused by trephine group, traditional group and open window group was 8.0% .23.1% .23.7%,the difference is statistically significant （P〈0.05）. neurectomy cured all of the 22 patients with neuropathic pain. Conclusion The diagnosis for nerve injury should take an integrated approach. Harvesting iliac bone with trephine cause lower incidence rate of nerve injury than open window group and traditional group, neurectomy mgkes good effect for the treatment of paresthesia and pain.