Bleton R, Alnot J Y, Oberlin C
Service de Chirurgie Orthopédique et Traumatique, Hôpital Bichat, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1993;79(3):205-17.
Fifty-two cases of nerves injuries involving the sciatic nerve or one of its two main branches (tibialis or peroneal nerve), between the sciatic notch and the knee, were treated by nerve grafts or nerve sutures. 26 cases were injured in the thigh. They were treated by 11 nerve sutures followed by good results in isolated lesions, and 15 nerve grafts. In 9 cases nerve loss was short and fascicular graft was possible. Clear cut injuries had satisfactory results. In 6 cases, nerve loss was extensive (> 10 cm), especially after sciatic nerve disruption following femoral bone fracture. There was not enough nerve graft available to repair the entire sciatic nerve. Tibialis nerve repair was chosen to restore plantar sensitivity. A vascular nerve graft of peroneal nerve could restore plantar sensitivity in all cases. 26 cases were injured around the knee and involved the peroneal nerve. In 12 cases the lesion was clear cut, treated in 10 cases with a short fascicular nerve graft, and in 2 cases by a suture. In most of the cases, results were good, better than that those obtained after tibialis posterior transfer. 14 cases had peroneal nerve disruption after a severe lateral sprain of the knee. Nerve damages were extensive and results were poor. Tendon transfer had to be done quite often.
52例坐骨切迹与膝关节之间涉及坐骨神经或其两大主要分支(胫神经或腓总神经)之一的神经损伤,采用神经移植或神经缝合进行治疗。26例在大腿部受伤。其中11例采用神经缝合,孤立性损伤效果良好,15例采用神经移植。9例神经缺损较短,可行束状移植,明确的切割伤效果满意。6例神经缺损广泛(>10cm),尤其是股骨骨折后坐骨神经断裂。没有足够的神经移植物来修复整个坐骨神经,选择修复胫神经以恢复足底感觉,腓总神经带血管神经移植在所有病例中均可恢复足底感觉。26例在膝关节周围受伤并累及腓总神经。12例损伤明确,10例采用短束状神经移植治疗,2例采用缝合治疗。大多数病例效果良好,优于胫后肌腱转位术后的效果。14例膝关节严重外侧扭伤后出现腓总神经断裂,神经损伤广泛,效果不佳,常需进行肌腱转位。