坐骨神经霰弹枪伤的手术治疗  

Surgical treatment of shotgun injuries of the sciatic nerve

作　　者：王军强[1] 伊明江[2] 诸寅[3] 王满宜[1] 张伯松[1] 刘德全[1] 危杰[1] 

机构地区：[1]北京大学积水潭医院创伤骨科,100035 [2]新疆医科大学附属巴州人民医院骨科 [3]北京大学积水潭医院手外科,100035

出　　处：《中华外科杂志》2004年第2期81-83,共3页Chinese Journal of Surgery

摘　　要：目的　探讨霰弹枪致坐骨神经损伤的临床特点及手术治疗方法、效果。　方法　 19例坐骨神经霰弹枪伤中 ,臀部损伤 2例 ,大腿部损伤 14例 ,窝部损伤 3例。枪伤射击距离在 0 5～9 0m之间 ,按霰弹枪的Shermen分型划分 ,Ⅰ型 4例 ,Ⅱ型 11例 ,Ⅲ型 4例。伤后至入院手术时间除1例为 4h外 ,其余均为 2～ 14个月。 1例行清创、神经外膜对端吻合术 ,7例行神经全干移值术 ,6例行神经电缆式移植 ,4例行神经松解术 ,1例行踝关节融合术。　结果　 19例患者随访 0 8～ 3 5年、平均 19个月 ,根据英国医学研究院神经外科学会制定的MCRR标准 ,坐骨神经损伤恢复的优良率为5 2 6 %。　结论　坐骨神经霰弹枪伤的伤情复杂 ,常合并开放骨折、血管损伤、软组织缺损及感染 ;神经损伤的性质多为Sunderland分度中的 4～ 5度损伤 ;手术治疗方法以神经移植为主 ,但预后不佳 ;神经损伤后应给予正确的初始治疗 ,在对损伤神经恢复状况认真的连续、动态观察的基础上 ,正确评估神经损伤性质 ,采取积极、恰当的手术治疗 ,同时注重神经营养药物、康复理疗等综合治疗 ,才能获得较好的手术效果。Objective To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve. Methods From 1996 to 2000,19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds,the gluteal wound was in 2 cases,thigh wound in 15 cases,and knee wound in 2 cases. The firing distance was between 0.5～9 m. According to Shermen classification of shotgun injury,4 cases belonged to type Ⅰ injury ,11 cases type Ⅱ,4 cases type Ⅲ. The time from injury to admission was between 2 monthes-14 monthes except 1 patient who underwent emergency operation 4 hours after injury,and 1 patient was treated with debridment and epineurial neurorrhaphy,7 cases with nerve trunk grafting,6 cases with nerve cable grafting,4 cases with neurolysis,1 case with arthrodesis of ankle. Results Nineteen cases were followed-up for 0.8-3.5 years(mean,19 months).The excellent and good nerve functional recovery was found in 52.6% according to MCRR. Conclusions Shotgun injuries of the sciatic nerve are very severe and complicated,and injuries in most patients were usually complicated by open fracture,varcular injury,soft-tissue loss and infection;the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve,but outcome is poor;the recovery of the sciatic nerve should be observed continually after injury;selecting correct initial treatment after injury,strict minimally invasive surgical procedure,physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.

关 键 词：坐骨神经 霰弹枪伤 治疗 外科手术 

分 类 号：R82[医药卫生—临床医学]