[臀坐骨神经损伤及其治疗]

Huang Y, Yan Q, Lei W

Institute of Orthopedics of PLA, Xijing Hospital, Fourth Military Medical University, Xi'an Shanxi, P. R. China 710032.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2000 Mar;14(2):83-6.

OBJECTIVE

To analysis the clinical characters of gluteal sciatic nerve injuries and investigate the treatment options.

METHODS

From October 1962 to June 1997, 190 patients with gluteal sciatic nerve injuries were adopted in this retrospective study. In these cases, the sciatic nerve injuries were caused by injection in 164 patients(86.32%), stab injury in 14 patients, pelvic fracture and hip dislocation in 11 patients, and contusion injury in 1 patient. Among them, 15 cases were treated by conservative method and the other 175 cases were operated. According to the observation during the operations, the injuries were occurred at the region of gluteal muscle in 146 cases, at the region of piriform muscle in 26 cases, and at the region of pelvic cavity in 3 cases. Then neurolysis was performed in 160 cases, epineurial neurorrhaphy in 12 cases and nerve grafting in 2 cases, and nerve exploration but no repair in 1 case. Late stage functional reconstruction of the foot and ankle was carried out in 23 cases.

RESULTS

One hundred and fifty-one patients were followed up 8.5 years in average. The occurrence of excellent and good nerve recovery was 56.95% and the occurrence of excellent and good functional reconstruction of late stage was 78.26%.

CONCLUSION

The gluteal sciatic nerve injury has since been challenging because of the tremendous difficulty in treatment and the poor outcome. The injury situation at the different region was closely related to the regional anatomy. According to this study, it is advised that the surgical treatment should be carried out actively. Neurolysis should be performed as soon as possible in the cases of injection injury. Epineurial neurorrhaphy 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 exploration and nerve repair is indicated in the late stage. The functional reconstruction of foot and ankle should be carried out in the late stage for the improvement of the limb function.

目的

分析臀段坐骨神经损伤的临床特点并探讨治疗方法。

方法

本回顾性研究纳入了1962年10月至1997年6月间190例臀段坐骨神经损伤患者。其中，坐骨神经损伤由注射引起的有164例（86.32%），刺伤14例，骨盆骨折及髋关节脱位11例，挫伤1例。其中15例采用保守治疗，其余175例接受手术治疗。根据术中观察，损伤发生在臀肌区域的有146例，梨状肌区域26例，盆腔区域3例。160例行神经松解术，12例行神经外膜缝合术，2例行神经移植术，1例行神经探查但未修复。23例行晚期足踝功能重建。

结果

151例患者平均随访8.5年。神经恢复优良率为56.95%，晚期功能重建优良率为78.26%。

结论

臀段坐骨神经损伤因其治疗难度大、效果差一直具有挑战性。不同区域的损伤情况与局部解剖密切相关。根据本研究，建议积极进行手术治疗。注射伤应尽早行神经松解术。神经断裂应行神经外膜缝合术。骨盆骨折或髋关节脱位所致臀段坐骨神经损伤，早期建议复位减压，晚期应行探查及神经修复。晚期应行足踝功能重建以改善肢体功能。