髋臼骨折脱位合并坐骨神经损伤的治疗和预后  

Treatment and Prognosis of Sciatic Nerve Injury Following Acetabular Fracture and Hip Dislocation

作　　者：任继鑫[1] 刘树清[1] 刘智[1] 李京生[1] 

机构地区：[1]北京军区总医院创伤骨科研究所,北京市100700

出　　处：《中国骨与关节损伤杂志》2010年第1期9-12,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的了解髋臼骨折脱位坐骨神经损伤概率、损伤程度,以及手术治疗与非手术治疗的疗效。方法自1999年7月～2007年8月收治208例髋臼骨折脱位合并坐骨神经损伤31例,手术治疗13例,非手术治疗18例。结果手术治疗的13例中8例有胫神经损伤表现,术前胫神经平均分为3.54分(按照LSUHSC评分),3例术后有恢复,4例完全恢复正常,1例未恢复,术后胫神经评分平均为4.77分。13例术前腓总神经平均分为2.23分,术后6例有恢复,2例恢复正常,5例没有恢复,术后腓总神经平均分为2.69分。非手术治疗的18例中14例有胫神经损伤,术前胫神经平均分为3.67分,13例有恢复,12例完全恢复正常,术后胫神经平均分为4.89分。非手术治疗病人都有腓总神经损伤,治疗前腓总神经平均分2.39分,治疗后13例有恢复,3例恢复正常,5例没有恢复,术后腓总神经平均分为3.39分。统计手术治疗与非手术治疗没有明显差异(P=0.206)。胫神经恢复好于腓总神经(P<0.01)。结论髋臼骨折引起的坐骨神经损伤,其中腓总神经分支损伤更多见、更严重,无论手术治疗还是非手术治疗恢复都比胫神经差;坐骨神经损伤手术治疗效果并不优于非手术治疗。Objective To investigate the incidence and the severity of the sciatic nerve injury in the patients with acetabular fracture and dislocation of hip, and to evaluate the clinical results of conservative treatment and operative treatment. Methods The 208 patients were retrospectively reviewed, 31 cases were complicated with sciatic nerve injuries, 13 cases were treated by operation and 18 cases were treated with conservative methods. Results The clinical findings of tibial nerve injury were observed in 8 of the 13 patients and the average preoperative functional evaluation score was 3.45 according to the LSUHSC system.Three patients acquired partial recovery, 4 patients completely recovered and 1 patient failed to recover. The average postoperative functional evaluation score was 4.77 accordingly. All the 13 patients treated by operation suffered the common peroneal nerve injury. After operation,the average functional score of common peroneal nerve was 2.69 compared with 2.23 preoperatively. Patients with complete and partial functional recovery of common peroneal nerve were 6 and 2 respectively. The rest 5 cases failed to recover. Among the 18 patients treated with conservative methods, 14 patients underwent tibial nerve injury. The average functional score of tibial nerve was 3.67 preoperatively and 4.89 postoperatively.Twelve patients completely recovered, 1 patient acquired partial recovery and 1 patient failed to recover. All of the conservative treatment patients underwent the common peroneal nerve injury, the average functional score of prior treatment and post-treatment was 2.29 and 3.39 respectively,3 patients completely recovered ,10 patients partially recovered and 5 patients failed to recover. No significant difference was found be- tween the conservative treatment group and the operative treatment group with regard to the treatment outcome （P=0.206）. The recovery of tibial nerve injury was significantly better than that of common peroneal nerve injury（P〈0.01）.Conclusion The injury of common p

关 键 词：髋臼骨折 坐骨神经损伤 胫神经 腓总神经 

分 类 号：R651.3[医药卫生—外科学] R683.306[医药卫生—临床医学]