儿童臀部坐骨神经损伤

目的：探讨儿童臀部坐骨神经损伤的临床特点及处理。方法：回顾性研究分析139例儿童臀部坐骨神经损伤的临床资料。损伤原因中药物注射伤133例,锐器伤4例,钝器伤1例,手术误伤1例。分别进行神经松解术104例,神经吻合术4例,胫后肌转移2例,胫前肌转移1例,非手术治疗10例。结果：139例中除10例保守治疗者外,139例得到0.5-21年（平均8.4)的随访。神经松解术104例中优良者58例,占55.77%;神经吻合术4例良1例,占25%;肌腱转移术优良者16例,占76.19%,结论：和童臀部坐骨神经损伤以注射伤为最常见。诊断明确后应尽早手术进行神经探查松解,年龄愈小,手术越早效果越好,对断裂伤应积极认真进行端端吻合,对上述治疗无效者可通过肌腱转移术,对大龄儿童可采用踝关节融僵术改善踝关节功能。     

臀部坐骨神经药物注射伤的手术治疗

目的 探讨臀部坐骨神经药物注射伤的发生机制、临床特点、治疗和预防。方法 经手术治疗并有随访结果的１２９例中，坐骨神经完全损伤１２例，不完全损伤２４例；坐骨神经的肢神经支完全及不完全损伤各１例；腓神经支完全损伤８６例，不完全损伤５例。１２３例做神经内、外松解术，１例做神经外膜切开减压冲洗术，５例未探查神经而行径后肌转移功能重建术。结果 平均随访８年５个月，神经松解减压术优良率为５７．２６％，功能重建     

坐骨神经霰弹枪伤的手术治疗

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,胭窝部损伤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52．6％。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。     

臀肌挛缩症皮下松解术相对安全区的确定及临床应用

[目的]通过解剖学研究探讨臀肌挛缩症手术操作的相对安全区,并在临床验证相对安全区皮下松解术治疗臀肌挛缩症的可行性.[方法]通过对51具尸体标本102侧臀部的解剖研究,确定臀部手术操作的相对安全区,并在临床应用.[结果]①臀肌拿缩症手术操作的相对安全区:臀上神经最下支的体表投影的弧线与大转子外侧最凸点形成一类扇形区域内重要血管神经分布,无论何种体位坐骨神经均无法到达该区域,为手术操作的相对安全区.②临床应崩23例,经12～29个月随访,平均19.7个月,术后患者均恢复正常步态或明显改善,均无坐骨神经损伤等严重并发症.[结论]臀肌挛缩症手术操作的相对安全区为臀上神经最下支的体表投影与大转子外侧最凸点所构成的类扇形区域,在此区域内操作不易损伤坐骨神经、臀上神经等重婴神经、血管,临床应用后,效果良好.     

臀部坐骨神经损伤及修复

目的　报告 190例臀部坐骨神经损伤的临床资料并探讨其处理方法。方法　药物注射伤 16 4例(占 86 .32 % ) ,锐器伤 14例 ,骨盆骨折、髋关节脱位合并伤 11例 ,臀部挫伤 1例。非手术治疗 15例 ,手术 175例。术中见损伤平面在臀大肌段 146例 ,梨状肌段 2 6例 ,盆腔段 3例。采用神经松解术 16 0例 ,神经外膜对端吻合 12例 ,神经移植术 2例 ,神经探查未修复神经 1例 ;2 3例做了后期足踝部功能重建术。结果　 15 1例获得 6个月～ 2 1年随访 (平均 8.5年 ) ,神经恢复的优良率为 5 6 .95 % ,后期功能重建的优良率为 78.2 6 %。结论　臀部坐骨神经损伤是周围神经损伤中最难处理和疗效最差的部位之一。其各段损伤与局部解剖关系密切。治疗应持积极态度 ,药物注射伤应争取尽早行神经松解术 ;神经断裂伤行外膜对端吻合术 ;骨盆骨折、髋脱位引起者 ,早期复位减压 ,后期须探查修复神经。晚期足踝部功能重建可改善肢体功能。     

臀部肌肉注射避免损伤坐骨神经的探讨

臀部肌肉注射是常见的给药途径,如果忽视了严格的操作规程,或只注意个体的一般性,而忽视了个体的特殊性,会损伤坐骨神经引起瘫痪。本文就臀部肌肉注射损伤坐骨神经的可能性及预防讨论如下: 一、从臀部解剖看坐骨神经损伤的可能性臀部的肌肉由浅入深依次为臀大肌、臀中肌、梨状肌和臀小肌等。经梨状肌上孔穿出骨盆的有臀上血管、臀上神经;通过梨状肌下孔穿出骨盆的血管神经,由外侧向内侧依次为:坐骨神经、股后皮神经、臀下血管、臀下神经、阴部内血管和阴部神经。大约有60.5％的坐骨神经从梨状肌下孔穿出后,在大转子与坐骨结节之间垂直下降至股后部,分为胫神经和腓总神经;另有39.5％的坐骨神经分支很高,胫神经从梨状肌下孔穿出,而腓总神经则经梨状肌上孔或穿过梨状肌。由于坐骨神经的变异型较     

髋臼骨折合并坐骨神经损伤的治疗(附20例报告)

目的　探讨髋臼骨折合并坐骨神经损伤的创伤机制及治疗。方法　分析本组髋臼骨折合并坐骨神经损伤共 2 0例 ,均行肌电图检查。 4例采用患肢持续股骨髁上牵引非手术治疗 ;16例采用髋臼骨折切开复位内固定手术治疗 ,术中视坐骨神经损伤程度作神经外膜松解或束间松解。结果　坐骨神经恢复情况 :优 7例 ,良 6例 ,可 4例 ,差 3例。结论　应根据临床检查 ,X线及CT所示骨折移位情况和有无髋关节后脱位 ,作电生理检查 ,结合临床有无造成神经严重损伤的因素而决定是否探查坐骨神经 ;术中肉眼观察坐骨神经损伤程度对指导手术和判断预后有一定意义 ,神经的恢复情况与术中所见损伤程度有关     

髋臼骨折合并坐骨神经损伤的治疗（附20例报告）

目的 探讨髋臼骨折合并坐骨神经损伤的创伤机制及治疗。方法 分析本组髋臼骨折合并坐骨神经损伤共20例，均行肌电图检查。4例采用患肢持续股骨髁上牵引非手术治疗；16例采用髋臼骨折切开复位内固定手术治疗，术中视坐骨神经损伤程度作神经外膜松解或束间松解。结果 坐骨神经恢复情况：优7例，良6例，可4例，差3例。结论 应根据临床检查，X线及CT所示骨折移位情况和有无髋关节后脱位，作电生理检查，结合临床有无造成神经严重损伤的因素而决定是否探查坐骨神经；术中肉眼观察坐骨神经损伤程度对指导手术和判断预后有一定意义，神经的恢复情况与术中所见损伤程度有关。     

手术治疗臀性坐骨神经痛32例

臀部组织受腰骶段脊神经后支及前支的双重支配,软组织覆盖的坐骨大孔为坐骨神经干的出口,臀部神经支、干或末梢受到伤害性刺激,均可能引起坐骨神经痛,我们统称之为“臀性坐骨神经痛”。我们从1974～1991年,对32例病程长、症状重、经保守治疗无效的臀性坐骨神经痛患者采用手术治疗,效果满意,报告如下:     

骶骨骨折的手术治疗

目的　探讨骶骨骨折及骶神经损伤的手术治疗方法。方法　对 30例骶骨骨折病例使用π棒内固定 ,对 9例伴有骶神经损伤症状的病例进行神经探查。结果　骨折均一期愈合 ,一例坐骨神经损伤未恢复 ,一例膀胱括约肌功能未恢复 ,治愈率达93 1%。结论　骶骨骨折内固定治疗可以恢复骶骨解剖关系 ,有利于神经恢复。对于伴有神经损伤症状者应同时进行神经探查。     

Posttraumatic gluteal compartment syndrome. A case report

Posttraumatic sciatic nerve palsy associated with severe pain, swelling in the gluteal region, elevated tissue pressures, and diffuse edema of the gluteal musculature documented by computed tomography (CT) occurred in a 22-year-old man. Diffuse muscle swelling was observed intraoperatively, and sciatic nerve function returned within days following surgical decompression. This case represents an acute gluteal compartment syndrome, and this entity should be included in the differential diagnosis of posttraumatic sciatic nerve palsy.     

臀肌挛缩症松解术合并坐骨神经损伤

目的：探讨臀肌挛缩症松解术中坐骨神经损伤的危险因素，预防及处理方法，方法：1983年5月－2001年2月，对960例患者行臀肌挛缩症松解术，导致坐骨神经损伤，采用早期手术探查，显微技术外膜吻合，结果：960例中坐骨神经损伤2例，占0．21％，均经早期手术探查，显微外科技术吻合，效果良好。结论：对中、重度臀肌挛缩症松解时要逐层解剖，暴露清楚，注意坐骨神经变异，一旦损伤，应早期采用显微外科技术修复。     

Missile injuries of the sciatic nerve.

Missile injuries of the sciatic nerve are not common in civil practice. We analysed a war series of 55 cases operated on in a period from 1991 to 1995. Nerve continuity was preserved at least partially in 76.4% of cases, but only 13.3% of cases had preserved some nerve function. Surgical results were analysed in 45 cases followed for more than two years. The rates of useful functional recovery were 86.7% for tibial division, 53.3% for peroneal division and 86.7% for the sciatic nerve complex. On the basis of the obtained results we were able to make the following conclusions: (1) missile injuries to the sciatic nerve are characterised by partially preserved nerve continuity and complete functional loss in the majority of cases, (2) surgery should be performed 3 to 6 months after injury, (3) reconstruction of tibial division is the major goal of surgical repair, (4) the extent and severity of nerve damage and the type of surgical procedure are the main prognostic factors and (5) failures of surgical repair are usually related to nerve grafting at gluteal level.     

Pseudoaneurysm of the inferior gluteal artery presenting as sciatic nerve compression

A pseudoaneurysm of the inferior gluteal artery presenting as sciatic nerve compression is reported in a 40-year-old woman. Following a transvaginal needle biopsy for endometriosis, the patient developed left sciatic pain and a nonpulsatile mass palpable in the left buttock thought to represent a pyriformis hematoma. Sequential computed tomographic scans were consistent with this diagnosis. Persistent pain and progression of neurological deficits led to surgical exploration. Posterior exposure of the pyriformis muscle and proximal sciatic nerve revealed a large pseudoaneurysm of the inferior gluteal artery compressing the nerve. A laparotomy was performed and the internal iliac artery was ligated, followed by evacuation of the aneurysm contents and repair of the aneurysm neck via a posterior approach. The patient has remained pain-free with progressive improvement in neurological function after 1 year follow-up. Aneurysms of the gluteal artery are unusual, predominantly occur after significant pelvic trauma, and rarely present as sciatica. Pertinent aspects of the patient history and clinical findings are atypical for discogenic sciatica. Because of the rarity of this entity, preoperative diagnosis is usually not achieved. Angiography or magnetic resonance imaging should be performed in patients with atypical sciatica and a mass in the region of the proximal sciatic nerve, particularly after trauma.     

Sciatic Nerve Injury in Total Hip Resurfacing : A Biomechanical Analysis

The condition of the gluteal sling was a significant factor in determining the pressure experienced by the sciatic nerve during acetabular exposure in total hip resurfacing via a posterior approach. The position of the knee did not play a significant role at this stage of the procedure. Average pressures were not elevated above a predefined injury level during positioning for femoral preparation. During hip reduction, knee positioning seemed to play a significant role in pressures placed on the sciatic nerve. These findings suggest that releasing the gluteal sling during a posterior approach for total hip resurfacing may help to prevent postoperative sciatic nerve palsies. Consideration should also be given to at least partially flexing the knee during hip reduction in this procedure.     

Histochemical study of retrograde degeneration in ligated peripheral nerves

The enzyme specificity of the Karnovsky staining was examined. Tetraisopropylpyrophosphoramide made the staining difference between anterior and posterior roots clearer. Rat sciatic nerve, gluteal muscle branch and sural nerve were ligated and retrograde changes were examined histologically and histochemically. In ligated sciatic nerve, axonal degeneration similar to Wallerian degeneration occurred within 5 mm proximal to ligation while acetylcholinesterase activity decreased in more proximal portions. Sections of ligated gluteal muscle branch showed marked increase of small myelinated fibers 6 weeks after ligation and the mean cross sectional area of myelinated fibers decreased due to the new small fibers. The mean cross sectional area of myelinated axons also decreased in ligated sural nerve but myelinated fibers did not so remarkably increase in number as ligated gluteal muscle branches. Histochemical funicular orientation could be reliable if performed soon after nerve injury before retrograde changes spread in the proximal stump.     

Acute proximal hamstring rupture

Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and most series have had a relatively small number of patients. Surgical repair results project 58% to 85% rate of return to function and sports activity, near normal strength, and decreased pain.     

Nerve injury in traumatic dislocation of the hip

Neurologic injury often accompanies traumatic dislocation and fracture-dislocation of the hip. A review of the literature reveals an incidence of approximately 10% in adults and 5% in children. The sciatic nerve, usually the peroneal branch, is most often injured, and this complication can be seen after all types of posterior fracture-dislocations and simple posterior dislocations. The sciatic nerve can be acutely lacerated, stretched, or compressed, or later encased in heterotopic ossification. Neurologic examination at the time of injury often is difficult but is extremely important. Once a nerve injury is discovered, prompt closed reduction must be attempted to relieve distortion of the nerve from a dislocated femoral head or displaced acetabular fracture. Considerable controversy surrounds the recommendations for additional treatment of nerve injury once the hip has been reduced. At least partial recovery of nerve function occurs in 60% to 70% of patients, with no clear correlation with injury or treatment type. Rehabilitation of patients with sciatic nerve injury must begin as early as possible and should focus on the prevention of an equinus foot deformity. Magnetic resonance neurography may become useful in the future for initial evaluation of patients with this injury.