Mathieu Laurent, Cloquell Yannick, Murison James Charles, Pfister Georges, Gaillard Christophe, Oberlin Christophe, Belkheyar Zoubir
Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France.
Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4955-4962. doi: 10.1007/s00068-022-02034-6. Epub 2022 Jul 20.
To evaluate functional results after treatment of large defects of the sciatic nerve and its divisions by direct nerve suturing in high knee flexion.
A retrospective review was conducted in patients treated for lower extremity nerve defects between 2011 and 2019. Inclusion criteria were a defect > 2 cm with a minimal follow-up period of 2 years for the sciatic nerve and 1 year for its divisions. Nerve defects were bridged by an end-to-end suture with the knee flexed at 90° for 6 weeks. Functional results were assessed based on the Medical Research Council's grading system.
Seventeen patients with a mean age of 27.6 years were included. They presented with seven sciatic nerve defects and ten division defects, including eight missile injuries. The mean time to surgery was 12.3 weeks and the mean nerve defect length was 5 cm. Overall, 21 nerve sutures were performed, with eight in the tibial distribution and 13 in the fibular distribution. Post-operatively, there was no significant knee stiffness related to the immobilization. The mean follow-up time was 24.5 months. Meaningful motor and sensory recovery were observed after 7 of 8 sutures in the tibial distribution and 11 of 13 sutures in the fibular distribution. A functional sural triceps muscle with protective sensibility of the sole was restored in all patients. There were no differences according to the injury mechanisms.
Temporary knee flexion at 90° allows for direct coaptation of sciatic nerve defects up to 8 cm, with promising results no matter the level or mechanism of injury.
评估在高屈膝位直接神经缝合治疗坐骨神经及其分支大缺损后的功能结果。
对2011年至2019年接受下肢神经缺损治疗的患者进行回顾性研究。纳入标准为缺损大于2 cm，坐骨神经最短随访期为2年，其分支为1年。神经缺损通过端对端缝合桥接，膝关节屈曲90°持续6周。根据医学研究理事会的分级系统评估功能结果。
纳入17例平均年龄27.6岁的患者。他们出现7例坐骨神经缺损和10例分支缺损，包括8例枪伤。平均手术时间为12.3周，平均神经缺损长度为5 cm。总体而言，进行了21次神经缝合，其中8次在胫神经分布区，13次在腓总神经分布区。术后，未出现与固定相关的明显膝关节僵硬。平均随访时间为24.5个月。在胫神经分布区的8次缝合中有7次、腓总神经分布区的13次缝合中有11次观察到有意义的运动和感觉恢复。所有患者均恢复了具有足底保护性感觉的功能性腓肠三头肌。根据损伤机制无差异。
临时膝关节屈曲90°可直接吻合长达8 cm的坐骨神经缺损，无论损伤水平或机制如何，均有良好结果。
