Poptodorov G, Gabrovski St, Bebechev G, Velinov N
Khirurgiia (Sofiia). 2009(6):57-60.
We describe a case of sciatic nerve entrapment neuropathy due to a posttraumatic heterotopic ossification (myositis ossificans traumatica). A 52 y.o. man was examined complaining from right lower limb pain and weakness progressing for one year after a blunt trauma and a hematoma of the hip. Clinical examination demonstrated sciatic nerve palsy with pain and paresthesia felt distal to the lesion. Electrodiagnostic studies show severe denervation changes in the tibialis anterior, extensor digitorum brevis and gastrocnemius muscles. Both radiography and CT scan revealed new bone formation in the soft tissue in the upper third of the hip. Surgical exploration discovered an osseous tunnel in the fascial plane between the semitendinous and biceps femoris muscles, encasing the sciatic nerve in a length of 12 cm. The lesion was hard and intimately associated with the epineuria. Histopathological examination of the lesion demonstrated mature, lamellar bone structure. Under optical magnification the ectopic bone was totally removed and decompression of the sciatic nerve was achieved. Nevertheless neurological recovery was absent at one year follow-up after surgery.
我们描述了一例因创伤后异位骨化(创伤性骨化性肌炎)导致的坐骨神经卡压性神经病变。一名52岁男性,在髋部遭受钝器伤并出现血肿后,因右下肢疼痛和无力进行性加重一年前来就诊。临床检查显示坐骨神经麻痹,病变远端有疼痛和感觉异常。电诊断研究表明,胫前肌、趾短伸肌和腓肠肌出现严重的失神经改变。X线摄影和CT扫描均显示髋部上三分之一软组织中有新骨形成。手术探查发现半腱肌和股二头肌之间的筋膜平面存在一个骨隧道,坐骨神经在12厘米的长度内被包裹其中。病变坚硬,与神经外膜紧密相连。病变的组织病理学检查显示为成熟的板层骨结构。在光学显微镜下将异位骨完全切除,实现了坐骨神经减压。然而,术后一年随访时神经功能未恢复。