Aboulfetouh Islam, Saleh Ahmed
Department of Neurosurgery Faculty of medicine, Benha University, Benha, Egypt,
Acta Neurochir (Wien). 2014 Oct;156(10):1979-86. doi: 10.1007/s00701-014-2202-x. Epub 2014 Aug 17.
The study included 11 patients; seven males and four females with mean age of 68.3 ±11 years. All patients had sciatic nerve entrapment: three had a penetrating injury, three suffered postoperative trauma, two had a crush injury, two had inadvertent injections and one was trapped in a machine belt. Clinical examination included: an evaluation of the extent of motor and sensory impacts according to the British Medical Research Council (BMRC) scale and the Semmes-Weinstein monofilament test; assessment of pain sensation using the visual analogue scale (VAS); electromyography; and nerve conduction velocitiey determination. The applied operative procedure for sciatic neurolysis was modulated according to the suspected site of sciatic nerve entrapment. At 6 and 12 months after surgery all patients were evaluated for recovery of motor and sensory function.
All patients passed the smooth intraoperative course within a mean operative time of 77.7 ±21 min. The mean duration of wound drainage and postoperative hospital stay was 2.6 ±0.7 and 4.8 ±0.8 days, respectively. Pain sensation showed progressive significant improvement in nine patients but decreased at time of discharge and remained stationary till 12-m post-operative (PO). Recovery of motor function showed progressive significant improvement at 6 and 12 months after sciatic nerve neurolysis. The frequency of patients having muscle power recovery and regained sensation was significantly higher at 6-m and 12-m PO as compared to preoperative grading with a significantly higher frequency at the 6-m grading compared to preoperative grading. Two patients showed no change of their muscle strength grade, while nine patients showed improvement for a total success rate of motor strength recovery of 81.8%. At 6- m PO five patients showed no change of their sensory group, while six patients showed improvement for a total success rate of sensation recovery of 54.5%. At 12-m PO ten patients had fullly recovered protective sensation for a success rate of 90.9%.
Surgical exploration and neurolysis of cases with sciatic nerve entrapment is a safe and effective therapeutic modality with significant improvement of both motor and sensory functions without risk of additional deficit secondary to neurolysis.
该研究纳入了11例患者，其中7例男性，4例女性，平均年龄为68.3±11岁。所有患者均患有坐骨神经卡压：3例有穿透伤，3例遭受术后创伤，2例有挤压伤，2例有意外注射伤，1例被困于机器皮带。临床检查包括：根据英国医学研究委员会（BMRC）量表和Semmes-Weinstein单丝试验评估运动和感觉影响的程度；使用视觉模拟量表（VAS）评估疼痛感觉；肌电图检查；以及神经传导速度测定。坐骨神经松解术的实施程序根据坐骨神经卡压的可疑部位进行调整。术后6个月和12个月对所有患者的运动和感觉功能恢复情况进行评估。
所有患者手术过程顺利，平均手术时间为77.7±21分钟。伤口引流的平均持续时间和术后住院时间分别为2.6±0.7天和4.8±0.8天。9例患者的疼痛感觉有显著的逐步改善，但在出院时有所下降，并一直保持稳定直至术后12个月。坐骨神经松解术后6个月和12个月，运动功能恢复有显著的逐步改善。与术前分级相比，术后6个月和12个月肌肉力量恢复和感觉恢复的患者频率显著更高，与术前分级相比，术后6个月分级时频率显著更高。2例患者的肌肉力量等级无变化，而9例患者有改善，运动力量恢复的总成功率为81.8%。术后6个月时，5例患者的感觉分组无变化，6例患者有改善，感觉恢复的总成功率为54.5%。术后12个月时，10例患者完全恢复了保护性感觉，成功率为90.9%。
坐骨神经卡压病例的手术探查和神经松解是一种安全有效的治疗方式，可显著改善运动和感觉功能，且无神经松解继发额外功能缺损的风险。
