Piza-Katzer Hildegunde, Schöller T, Stichelberger M
Klinik für Plastische und Wiederherstellungschirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria.
Handchir Mikrochir Plast Chir. 2009 Aug;41(4):230-7. doi: 10.1055/s-2008-1039296. Epub 2009 Mar 2.
With the increasing number of orthopaedic and gynaecologic operations also the number of iatrogenic nerve lesions has increased. The femoral nerve is especially at risk because of its anatomic course. In this study we take a look at the most frequent causes of iatrogenic femoral nerve lesions, their therapy and prevention.
From January 2000 to June 2008 13 patients (10 f, 3 m) with iatrogenic femoral nerve injuries underwent surgery. 7 (53.9 %) of the lesions were caused by the implantation of a hip prothesis, 2 (15.4 %) by the resection of a tumour and one each by an abdominal hysterectomy, spinal surgery, femoral block and by wearing a corsette because of scoliosis for more than one year. In femoral nerve lesions neurolysis was performed in 12 cases (92.3 %) and nerve transplantation in 1 case (7.7 %).
Surgery results were excellent (M4, S4) to fair (M3, S2). The most important factor for a good result was the time period between injury and surgery.
Femoral nerve lesions have a good prognosis if they are diagnosed in time and treated surgically when there are no signs of spontaneous recovery.
随着骨科和妇科手术数量的增加,医源性神经损伤的数量也在上升。股神经因其解剖走行尤其容易受损。在本研究中,我们探讨医源性股神经损伤最常见的原因、治疗方法及预防措施。
2000年1月至2008年6月,13例医源性股神经损伤患者(10例女性,3例男性)接受了手术治疗。其中7例(53.9%)损伤由髋关节假体植入引起,2例(15.4%)由肿瘤切除引起,另外各有1例分别由腹部子宫切除术、脊柱手术、股神经阻滞以及因脊柱侧弯佩戴束腹带超过一年引起。在股神经损伤病例中,12例(92.3%)进行了神经松解术,1例(7.7%)进行了神经移植术。
手术效果从优(M4,S4)到良(M3,S2)。取得良好效果的最重要因素是损伤与手术之间的时间间隔。
如果能及时诊断且在没有自发恢复迹象时进行手术治疗,股神经损伤预后良好。