健侧骶1为动力源神经移位修复骶丛撕脱伤病例报告及文献回顾  

Repairing sacral plexus avulsion with the S1 nerve at the uninjured side as its power source： case report and literature review

作　　者：陈爱民[1] 江曦[1] 李永川[1] 鹿楠[1] 杨迪[1] 张志凌[1] 郭清河[1] 李钧[1] 朱清华[1] 

机构地区：[1]第二军医大学长征医院创伤骨科,上海200003

出　　处：《中华创伤骨科杂志》2011年第11期1034-1038,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（30973054）

摘　　要：目的探讨健侧S1作为动力源神经修复1例骶丛撕脱伤的安全性与有效性。方法2007年11月收治1例骨盆骨折伴左下肢功能障碍3个月患者，男性，10岁。术前检查：左臀部、大腿后侧、小腿外侧及足部皮肤感觉麻木或缺失，左髋外展、左膝屈曲和足踝部活动丧失。X线片示左骶髂关节分离术后、左耻骨上下支骨折。椎管照影显示左侧L4～S1根部假性硬膜囊肿。肌电图检查提示骶丛神经损伤。在全身麻醉下行左侧骶丛神经探查＋健侧S1移位、腓总神经移植修复臀上神经和股二头肌肌支，左侧闭孔神经移位、腓总神经移植修复部分胫神经术。结果该患者手术时间为5h，术中出血量约2000mL，输血量为1600mL。术后患者伤口一期愈合。术后4d右侧下肢髋外展、后伸、屈膝与踝关节跖屈、背伸活动基本无影响，踝关节外翻稍减弱；足底、足趾外侧部分皮肤感觉减退，面积约4cm×12cm；术后20d，皮肤感觉减退面积约为2cm×6cm。术后18个月随访，右足底皮肤感觉减退区消失，感觉恢复正常，右下肢感觉、运动功能恢复正常；左侧髋关节外展、膝关节屈曲肌力达3级，踝关节功能无恢复。结论利用S1作为新动力源神经移位修复骶丛撕脱伤可能是一种安全而有效的手术术式。Objective To elevate safety and efficacy of repairing sacral plexus avulsion with transfer of the SI nerve at the uninjured side as its power source nerve. Methods In November 2007, a 10-year-old boy was admitted into our institute who had undergone surgery in a local hospital for a complex pelvic fracture with dissociation of the sacroiliac joint. Preoperative check-ups showed anesthesia in the glutei, hamstrings, and calf muscles of the left lower limb. X-ray revealed a previous operation on the sacroiliac joint, fractures of the superior and inferior rami of the left pubis, and dislocation of the pubic symphysis. A lumbar myelogram showed multiple pseudomeningoceles involving the right L4 to S1 nerve roots, indicating sacral nerve root avulsion. Electromyography presented a neurogenic injury. Neuropotentials of the left tibial nerve and peroneal nerve disappeared. A surgical reconstruction of the sacral nerve was performed 3 months after the injury, with a nerve graft of approximately 15 cm in length from the common peroneal nerve. One end of the nerve graft was anastomosed to the proximal stump of the right S1 nerve root. The distal end of the nerve graft was divided into 2 fascicles, one sutured to the left superior giuteal nerve and the other to the branch of the sciatic nerve innervating hamstrings. Results The operation lasted 5 hours, with perioperative blood loss of 2000 mL and blood transfusion of 1600 mL. The wound healed primarily. The right lower limb had nearly normal motions 4 days after operation. The patient had numbness in the lateral plantar region of the healthy limb （4 cm ×12 cm in area） 4 days after surgery, improved （2 cm × 6 cm in area） 20 days after surgery, and the symptom disappeared within 18 months. The strength of the glutei and hamstrings muscles at the left limb improved to the level of M3 18 months after surgery. The patient had M4 weakness in the peroneus longus which recovered within one year. Conclusion The S1 root of the plexus from the healthy side can be considere

关 键 词：腰骶丛 骨盆 骨折 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]