注射性坐骨神经损伤的原因与外科治疗  

The Causes and Surgical Treatment of Sciatic Nerve Injury Caused by Injection

作　　者：吴清君 赵传印 马俊腾 

机构地区：[1]河南省周口市中医院,河南周口466000

出　　处：《中国医学创新》2013年第31期17-19,共3页Medical Innovation of China

摘　　要：目的:探讨臀部肌肉注射性坐骨神经损伤的发生机制及诊治方法,并结合15具尸体标本30条坐骨神经的解剖走行特点分析其损伤原因。方法:回顾性总结1995年10月-2012年10月本院收治的23例采用手术治疗的患者临床资料,观察治疗效果;并通过15具尸体标本和23例手术患者共53条坐骨神经归纳坐骨神经穿出梨状肌前后的分支类型,论述坐骨神经伤的医源性和解剖学原因。结果:(1)23例患者中,术后1周症状完全恢复4例,基本恢复7例;术后随访3个月:完全恢复11例,基本恢复6例,部分恢复6例;术后6个月:完全恢复16例,基本恢复5例,部分恢复2例,治愈率69.6%;(2)15具尸体30条坐骨神经对照组变异比例小于正常变异比例;23例坐骨神经损伤的病例中,有4例为Ⅰ型,1例为Ⅱ型,14例为Ⅲ型,4例为Ⅳ型,变异比例82.6%,且损伤者多为小儿。结论:注射性坐骨神经损伤不仅与注射操作不规范所致的机械刺激、药物毒性、瘢痕压迫有关,主要与坐骨神经的解剖学结构和走行变异有关。解剖学结构中小儿臀大肌发育差、臀部小和坐骨神经走行变异是其注射性损伤的物质基础;外科治疗是坐骨神经损伤修复的有效方法。Objective： To explore the pathogenesis and the diagnosis and treatment of gluteal muscle injection sciatic nerve injury, to combine with specimens of 15 bodies article 30 sciatic nerve anatomic characteristics analysis of the causes of injury. Method： The clinical data of 23 patients by operation treatment in our hospital in October 1995 to October 2012 were retrospectively analyzed, 15 cadaver specimens and 23 patients a total of 53 sciatic nerve after sciatic nerve passes through the inductive branch type piriformis, discussed the reason of iatrogenic sciatic nerve injury and anatomy. Result： （ 1 ） Among the 23 cases, 1 weeks after the operation, 4 cases were completely recovered, 7 cases of the basic recovery＇; After 3 months follow- up： 11 cases completely recovered, restored in 6 cases, partial recovery in 6 cases; 6 months after operation： complete recovery in 16 cases, the basic recovery in 5 cases, partial recovery in 2 cases, the cure rate was 69.6%; （ 2 ） The 15 bodies 30 sciatic nerve the control group was less than the normal variation ratio variation ratio; 23 cases of sciatic nerve injury, 4 cases of type I , 1 cases type I, 14 cases of type ~, 4 cases of type 1V, variation ratio of 82.6%, and the damage for more children. Conclusion： Injection of sitting bone nerve injury not only with the injection operation is not standard caused by mechanical stimulation, drug toxicity, sear oppression, main and sciatic anatomical structure of neural and walking variability. Difference, hips and sciatic nerve in children with gluteal muscle developmental anatomy structure in variation is the material base of injection injury; surgical therapy is an effective method for the repair of sciatic nerve injury.

关 键 词：肌肉注射 坐骨神经 医源性损伤 解剖 外科手术 

分 类 号：R651.3[医药卫生—外科学]