Wang Jun-qiang, Yi Ming-jiang, Zhu Yin, Wang Man-yi, Zhang Bo-song, Liu De-quan, Wei Jie
Department of Orthopaedic Surgery and Traumatology, Beijing Jishuitan Hospital, Medical School, Peking University, Beijing 100035, China.
Zhonghua Wai Ke Za Zhi. 2004 Jan 22;42(2):81-3.
To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve.
From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle.
Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR.
Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.
探讨坐骨神经猎枪伤的临床特点及手术治疗效果。
观察1996年至2000年间19例坐骨神经猎枪伤。19例坐骨神经枪伤中，臀部伤口2例，大腿伤口15例，膝部伤口2例。射击距离为0.5 - 9米。根据Shermen猎枪伤分类，Ⅰ型损伤4例，Ⅱ型11例，Ⅲ型4例。受伤至入院时间为2个月至14个月，1例受伤后4小时行急诊手术，1例行清创及神经外膜缝合术，7例行神经干移植，6例行神经束移植，4例行神经松解术，1例行踝关节融合术。
19例随访0.8 - 3.5年（平均19个月）。根据MCRR标准，神经功能恢复优良率为52.6%。
坐骨神经猎枪伤伤情严重且复杂，多数患者常合并开放性骨折、血管损伤、软组织缺损及感染；根据Sunderland标准，神经损伤程度为4 - 5度，神经移位术对坐骨神经猎枪伤治疗有效，但效果不佳；伤后应持续观察坐骨神经恢复情况；伤后选择正确的初始治疗、严格的微创手术操作、物理治疗及合理的术前术后用药可提高手术效果。
