臀部坐骨神经损伤及修复

GL UTEAL SCIATIC NERVE INJURY AND ITS TREATMENT

目的 报告 190例臀部坐骨神经损伤的临床资料并探讨其处理方法。方法 药物注射伤 16 4例(占 86 .32 % ) ,锐器伤 14例 ,骨盆骨折、髋关节脱位合并伤 11例 ,臀部挫伤 1例。非手术治疗 15例 ,手术 175例。术中见损伤平面在臀大肌段 146例 ,梨状肌段 2 6例 ,盆腔段 3例。采用神经松解术 16 0例 ,神经外膜对端吻合 12例 ,神经移植术 2例 ,神经探查未修复神经 1例 ;2 3例做了后期足踝部功能重建术。结果 15 1例获得 6个月～ 2 1年随访 (平均 8.5年 ) ,神经恢复的优良率为 5 6 .95 % ,后期功能重建的优良率为 78.2 6 %。结论 臀部坐骨神经损伤是周围神经损伤中最难处理和疗效最差的部位之一。其各段损伤与局部解剖关系密切。治疗应持积极态度 ,药物注射伤应争取尽早行神经松解术 ;神经断裂伤行外膜对端吻合术 ;骨盆骨折、髋脱位引起者 ,早期复位减压 ,后期须探查修复神经。晚期足踝部功能重建可改善肢体功能。

Objective To analysis the clinical characters of gluteal sciatic nerve injuries and investigate the treatment options.Methods From October196 2 to June1997,190 patients with gluteal sciatic nerve injuries were adopted in this retrospective study.In these cases,the sciatic nerve injuries were caused by injection in16 4 patients(86 .32 % ) ,stab injury in14patients,pelvic fracture and hip dislocation in11patients,and contusion in- jury in1patient.Among them,15 cases were treated by conservative m ethod and the other175 cases were operat- ed.According to the observation during the operations,the injuries were occurred at the region of gluteal muscle in146 cases,at the region of piriform muscle in2 6 cases,and at the region of pelvic cavity in3cases.Then neu- rolysis was performed in16 0 cases,epineurial neurorrhaphy in12 cases and nerve grafting in2 cases,and nerve exploration but no repair in1case.L ate stage functional reconstruction of the foot and ankle was carried outin2 3 cases.Results One hundred and fifty- one patients were followed up8.5 years in average.The occurrence of ex- cellent and good nerve recovery was5 6 .95 % and the occurrence of excellent and good functional reconstruction of late stage was78.2 6 % .Conclusion The gluteal sciatic nerve injury has since been challenging because of the tremendous difficulty in treatment and the poor outcom e.The injury situation at the different region was closely related to the regional anatomy.According to this study,it is advised that the surgical treatm entshould be carried out actively.Neurolysis should be perform ed as soon as possible in the cases of injection injury.Epineurial neuror- rhaphy should be performed in the cases of nerve rupture.In case of the gluteal sciatic nerve injury which caused by pelvic fracture or hip dislocation,the reduction and decompression is suggested in the early stage,and explo- ration and nerve repair is indicated in the late stage.The functional reconstruction of foot and ankle should be car- ried out in the late stage for the im provement of the lim b function.