Management and outcomes in 353 surgically treated sciatic nerve lesions
Management and outcomes in 353 surgically treated sciatic nerve lesions
复制标题
DOI：
10.3171/jns.2004.101.1.0008
复制
发表时间：
2004-07-01
影响因子：
4.1
通讯作者：
Kline, DG
中科院分区：
文献类型：
--
作者：
Kim, DH;Murovic, JA;Kline, DG
对象。本文回顾性分析了353例手术治疗的坐骨神经病变，报道了损伤机制、部位、手术修复时间、手术技术和功能结果。研究结果为这些损伤的处理提供指导。1968年至1999年间，路易斯安那州立大学健康科学中心对175名臀部坐骨神经损伤患者和178名大腿坐骨神经损伤患者进行了手术治疗。臀部损伤机制包括64例注射，26例髋部骨折/脱位，22例挫伤，19例压迫，17例枪伤，15例髋关节置换术，12例撕裂伤；在大腿水平，62例为GSW， 34例为股骨骨折，32例为撕裂伤，28例为挫伤，12例为压迫，10例为医源性损伤。发现术中神经动作电位（NAPs）阳性的坐骨神经分裂患者行神经松解术，124例患者中有108例（87%）和95例患者中有91例（96%）达到了3级以上的功能结果，而119例患者中有84例（71%）和95例腓骨神经分裂患者中分别有75例（79%）达到了3级以上的功能结果。在缝合修复中，11例臀段损伤中有8例（73%）恢复到3级以上，29例股骨段胫骨分裂损伤中有27例（93%）恢复到3级以上，10例臀段损伤中有3例（30%），29例股骨段腓骨分裂损伤中有20例（69%）恢复到3级以上。对于移植物修复，34例中21例（62%）和54例中43例（80%）的髋部和大腿水平的胫骨分裂，即使在近端修复需要长移植物，也分别有良好的恢复，37例中只有9例（24%）和49例髋部和大腿水平的腓骨分裂病变中只有22例（45%）。在选定的病例中，在NAP阳性读数后进行手术探查和神经松解术，或在NAP阴性结果后进行缝合或移植物修复是值得的。
Object. This is a retrospective analysis of 353 surgically treated sciatic nerve lesions in which injury mechanisms, location, time to surgical repair, surgical techniques, and functional outcomes are reported. Results are presented to provide guidelines for management of these injuries.Methods. One hundred seventy-five patients with buttock-level and 178 with thigh-level sciatic nerve injury were surgically treated at the Louisiana State University Health Sciences Center between 1968 and 1999. Buttock-level injury mechanisms included injection in 64 patients, hip fracture/dislocation in 26, contusion in 22, compression in 19, gunshot wound (GSW) in 17, hip arthroplasty in 15, and laceration in 12; at the thigh level, GSW was the cause in 62 patients, femoral fracture in 34, laceration in 32, contusion in 28, compression in 12, and iatrogenic injury in 10. Patients with sciatic nerve divisions in which positive intraoperative nerve action potentials (NAPs) were found underwent neurolysis and attained at least Grade 3 functional outcomes in 108 (87%) of 124 and in 91 (96%) of 95 buttock- and thigh-level tibial divisions, respectively, compared with 84 (71%) of 119 and 75 (79%) of 95, respectively, in the peroneal divisions. For suture repair, recovery to at least Grade 3 occurred in eight (73%) of 11 buttock-level and in 27 (93%) of 29 thigh-level tibial division injuries, and in three (30%) of 10 buttock-level and 20 (69%) of 29 thigh-level peroneal division lesions. For graft repair, good recovery occurred in 21 (62%) of 34 and in 43 (80%) of 54 buttock- and thigh-level tibial divisions, respectively, even in proximal repairs requiring long grafts, and in only nine (24%) of 37 and 22 (45%) of 49 buttock- and thigh-level peroneal division lesions, respectively.Conclusions. Surgical exploration and neurolysis after positive NAP readings, or repair with sutures or grafts after negative NAP results are worthwhile in selected cases.