Kemler Marius A, de Vries Mattijs, van der Tol Anno
Department of Surgery, Martini Hospital, Groningen, the Netherlands.
Clin Orthop Relat Res. 2006 Apr;445:230-2. doi: 10.1097/01.blo.0000203462.27937.
An unknown percentage of patients who have internal fixation for hip fractures have sciatic neuropathy develop. In most cases, the cause for this complication is unknown. We retrospectively reviewed 2202 consecutive patients treated in our hospital for hip fractures to ascertain whether there was any relationship between duration of preoperative traction and postoperative sciatic neuropathy, and to determine the incidence of sciatic neuropathy after surgery for hip fractures. All patients had preoperative skin traction. Patients with and without sciatic neuropathy were compared using nonparametric tests. The median duration of traction was 2.6 days in the group that had sciatic neuropathy develop and 0.9 days in the group that did not. Also, patients in the group that had sciatic palsy develop were older. There seemed to be no other difference between the groups for any of the studied variables. Sixteen patients (0.7 %) had postoperative sciatic neuropathy. Our data suggest sciatic neuropathy after surgery for hip fractures may be related to the duration of preoperative traction. Some investigators have reported that there seems to be no evidence of benefit from skeletal or skin traction. A potential for damage to the sciatic nerve may be an argument to stop routine use of preoperative traction.
Diagnostic study, Level III (study of nonconsecutive patients; without consistently applied reference "gold" standard).
接受髋部骨折内固定治疗的患者中，出现坐骨神经病变的比例未知。在大多数情况下，这种并发症的病因不明。我们回顾性研究了我院连续收治的2202例髋部骨折患者，以确定术前牵引时间与术后坐骨神经病变之间是否存在关联，并确定髋部骨折手术后坐骨神经病变的发生率。所有患者术前均接受皮肤牵引。对出现和未出现坐骨神经病变的患者进行非参数检验比较。出现坐骨神经病变的组中，牵引的中位时间为2.6天，未出现病变的组为0.9天。此外，出现坐骨神经麻痹的组中的患者年龄更大。在所研究的任何变量方面，两组之间似乎没有其他差异。16例患者（0.7%）术后出现坐骨神经病变。我们的数据表明，髋部骨折手术后的坐骨神经病变可能与术前牵引时间有关。一些研究者报告称，似乎没有证据表明骨骼牵引或皮肤牵引有益。坐骨神经受损的可能性可能成为停止常规使用术前牵引的一个理由。
诊断性研究，III级（对非连续患者的研究；未始终应用参考“金”标准）。
