Sciatic neuropathy secondary to a uterine fibroid: a case report

Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.     

Gluteal muscular and sciatic nerve metastases in advanced urinary bladder carcinoma:

We present a case of gluteal muscular and sciatic nerve metastases from urinary bladder carcinoma. T2-weighted magnetic resonance images demonstrated diffuse swelling and an increase in the signal of the right gluteus maximus muscle without destruction of the original arrangement of muscular fibers. Further, remarkable thickening of the right sciatic nerve showing a relatively hypointense signal was detected. Postcontrast T1-weighted images showed strong enhancement of these structures. Fine-needle aspiration biopsy with ultrasonographic guidance confirmed metastatic carcinoma cells in the right gluteal muscle and the sciatic nerve. These radiologic findings may represent a rare pattern of metastasis from urinary bladder carcinoma.     

Sciatic neuropathy caused by disorder of a nutrient artery: a case report of thromboembolism secondary to profunda femoral artery aneurysm

This report describes a case of sciatic neuropathy caused by an obstruction of the nutrient artery of the nerve. The patient was a 76-year-old man who had an aneurysm in his right thigh and suddenly complained of pain and weakness in his right leg. Computed tomography scan and ultrasonography of the right thigh showed an aneurysm with a thrombus in the lumen of the profunda femoral artery. His symptoms did not immediately improve after the aneurysm had been resected, and were consistent with right sciatic neuropathy. Recovery of strength of the right tibialis anterior muscle from 0/5 to 3/5 required 12 months. In this case, thromboemboli from the aneurysm were thought to have obstructed the profunda femoral artery, which supplied the sciatic nerve via perforating arteries.     

借助人工神经修复大鼠坐骨神经缺损的实验研究

目的：研究人工神经－壳聚糖复合胶大气层 管修复大鼠坐骨神经15mm缺损的可行性。方法：借助人工神经修复10只大鼠坐骨神经缺损15mm，神经缺损7只为对照组，术后2个月，4个月行免疫组化，Osmium染色、Bodian染色，运动终板的特异染色、WGA－HRP神经示踪及大体观察。结果：术后2个月再生神经修复了坐骨神经的缺损，实验动物未出现排斥反应及明显的炎症反应。结论：人工神经导管对缺损的坐骨神经修复具有良好的桥梁作用和促神经生长的作用。     

Persistent sciatic artery with monoplegia in right lower leg without vascular complication symptoms in an obese woman

A rare case of a persistent sciatic artery (PSA) in a patient with monoplegia of the right lower leg without vascular complication symptoms is presented. A 44-year-old nervous and obese woman was referred with monoplegia of the right lower extremity. She was referred with an impression of a peripheral neuropathy due to nerve compression by a large uterine cyst. This impression was derived from a computed tomography (CT) scan that had been performed at the referring hospital the day before. On admission to our hospital, we repeated the CT scan and also obtained angiography that demonstrated that the problem was due to a persistent sciatic artery (PSA). The cyst was proved not to compress any vessels or nerves. The PSA was an aneurysmal dilatation from the internal iliac artery to the popliteal artery. It intermittently compressed the sciatic nerve. A persistent sciatic artery was noted to be the dominant blood supply to the right lower extremity. A right ilio-popliteal artery bypass using a 6-mm ringed ePTFE graft was performed. After arterial reconstruction, she recovered completely.     

人工全髋关节置换术中坐骨神经损伤的应用解剖学观察

背景人工全髋关节置换术(THR)是近年来治疗老年人髋关节疾患的首选方法,按Harri's评分优良率为84%.该手术对坐骨神经损伤发生率国内报道为0.46%,国外报道为0.08%～9.70%.目的通过解剖位置的分析探讨THR术中坐骨神经损伤的因素.设计以人体解剖标本为研究对象,单一样本研究.单位湖州师范学院医学院解剖实验室.对象实验于2003-03/05在湖州师范学院医学院解剖实验室完成.正常人体成年骨盆标本56具,男27具,女29具.方法对坐骨神经的来源及走行、坐骨神经与髋臼的关系进行测量分析,并对在THR术中拉钩及螺丝钉固定所致坐骨神经损伤,进行详尽测量分析. 主要观察指标坐骨神经与髋臼的位置关系.结果测出坐骨神经至髋臼底的距离左侧为(6.00±0.85)mm,右侧为(6.00±0.71)mm;坐骨神经至髋臼缘的距离左侧为(13.00±0.75)mm,右侧为(14.00±0.06)mm.坐骨神经在髋臼缘处周径左侧为(32.00±0.28)mm,右侧为(31.00±0.68)mm.髋臼底至坐骨大孔的距离为左侧为(29.00±0.36)mm,右侧为(29.00±0.24)mm.结论确定拉钩及螺丝钉固定在1～3点及5～6点为安全区.在THR术中陈旧髋臼骨折脱位、拉钩的位置不当、螺钉固定髋臼位置不当均可导致医源因素损伤坐骨神经.     

化学去细胞神经同种异体移植后近期感觉及运动传导功能的神经电生理观察

目的以化学去细胞同种异体坐骨神经移植修复犬坐骨神经的粗大和长段缺损,观察其近期神经电生理恢复.方法12犬随机分成去细胞神经移植组(实验组)和自体神经移植组(对照组)各6犬.右侧坐骨神经造成5.0cm长缺损,以两种神经移植物桥接修复.术后6个月行神经电生理观察,包括小腿三头肌运动诱发电位、神经移植段运动传导速度、感觉诱发电位等.结果①方波(1.0～2.0 mA,0.1 ms,1.0 Hz)刺激移植段近侧神经,均在小腿三头肌上记录到运动诱发电位曲线.②神经移植段运动传导速度,实验组平均为47.2 m/s,对照组为60.9 m/s,正常值为122.0 m/s.③方波(5.0～10.0 mA,0.2 ms,1.9 Hz)刺激胫神经远端,均在颅顶部记录到感觉诱发电位曲线;两组动物的感觉恢复程度相似,但均不及正常侧.结论化学去细胞神经同种异体移植修复犬坐骨神经长段缺损,术后6个月近期感觉及运动传导功能恢复与自体神经移植相似.     

Sciatic nerve compression by preexisting heterotopic ossification during general anesthesia in the dorsal lithotomy position

This report documents the 4th patient reported with sciatic nerve compression by heterotopic ossification and the 1st case occurring during general anesthesia. A 25-year-old woman developed right sciatic nerve dysfunction after a 30-minute dilatation and curettage in the dorsal lithotomy position. Postoperative x-rays revealed a large area of heterotopic ossification above the right greater trochanter. The patient had sustained a traumatic midshaft fracture of the right femur seven years previously, which required intramedullary nail fixation. It is postulated that during the D and C in the dorsal lithotomy position, the heterotopic ossification was displaced posteromedically, compressing the sciatic nerve that had already been placed at maximal stretch. The patient recovered partially. Electrodiagnostic studies were of considerable value in localization of the lesion and confirmation of the mechanism of injury. It is concluded that preexisting heterotopic ossification of the hip may compress the sciatic nerve during surgery in the dorsal lithotomy position.     

腹腔联合注射氯胺酮及可乐定对CCI模型大鼠的镇痛效应

目的:研究氯胺酮及可乐定对慢性神经病理性疼痛模型大鼠的镇痛作用,并探讨其可能机制.方法:雄性SD大鼠60只,体重180～220g,随机分为假手术组(S组)、生理盐水组(NS组)、可乐定组(CL组)、氯胺酮组(K组)及氯胺酮+可乐定(KC组)组,每组12只.采用坐骨神经慢性压迫法(CCI)制备大鼠神经病理性痛模型,S组仅暴露坐骨神经,不结扎.K组、CL组和KC组于术后3～14d每天分别腹腔注射氯胺酮(10mg/kg)、可乐定(1m/kg)、氯胺酮(5mg/kg)+可乐定(0.5m/kg),S组和NS组腹腔注射等容量生理盐水.各组分别于术前、术后3、7、14d测定机械痛阈和热痛阈值,术后3、7、14d测定痛阈值后每组随机取4只大鼠断头处死,取腰段脊髓(L4～L6)背根神经节(DRG),采用逆转录PCR法(RT-PCR)检测GAP-43mRNA的表达水平.结果:与S组比较,NS组、K组、CL组和KC组术后机械痛阈和热痛阈降低,NS组、K组和CL组DRG中GAP-43mRNA表达上调,KC组仅在术后3d DRG中GAP-43mRNA表达上调(P＜0.05);与C组比较,K组、CL组和KC组术后机械痛阈和热痛阈升高,DRG中GAP-43mRNA表达下调(P＜0.05);与K组和CL组比较,KC组术后7、14d时机械痛阈和热痛阈升高,DRG中GAP-43mRNA表达下调(P＜0.05).结论:氯胺酮与一定剂量的可乐定联合应用能抑制神经病理性疼痛大鼠机械性触诱发痛和热痛觉过敏的形成,减少大鼠脊髓DRG中GAP-43mRNA的表达,具有显著的协同镇痛作用.     

应用结合bFGF的壳聚糖导管修复大鼠坐骨神经损伤的实验研究

目的观察用结合碱性成纤维细胞生长因子(bFGF)的壳聚糖导管促进周围神经损伤再生的情况。方法实验组10只成年Wistar大鼠造成10 mm坐骨神经缺损后,以结合bFGF的壳聚糖导管作桥梁桥接神经两断端,以假手术组和单纯损伤组(造成10 mm坐骨神经缺损后,不加以任何干预措施)各10只大鼠为对照。术后3个月,通过大体观察、形态学及电生理检查观察损伤神经的再生情况。结果术后3个月,实验组大鼠新生的神经纤维已通过缺损部位,手术局部未出现明显的炎症反应,各项指标明显优于单纯损伤组。结论结合bFGF的壳聚糖导管对缺损的坐骨神经修复具有良好的桥梁作用和促进神经生长的作用。     

正常成人近段坐骨神经的弥散张量成像

背景：弥散张量成像及神经纤维束示踪的出现为外周神经细微结构的显示及定量分析提供了新的方法。目的：前瞻性分析健康成人大腿近段坐骨神经纤维束示踪、弥散张量成像的可行性及最佳成像参数。方法：采用单次激发自旋回波-平面回波技术对28名健康志愿者双侧坐骨神经进行弥散张量成像及神经纤维束示踪,b值分别为1200,1400,1600s/mm2。结果与结论：弥散张量成像及神经纤维束示踪成功者26名,成功率93%,神经纤维束示踪图上能清晰显示近段坐骨神经,与T1WI上解剖图像融合较好。两侧坐骨神经具有相同的弥散特征：随着b值增加,信噪比逐渐减少,b值为1200s/mm2,信噪比值最大为142.72±32.25,神经纤维束长度最长,所占体素最大,但不同b值的弥散张量参数无差异（P〉0.05）,且两侧坐骨神经弥散张量参数无差异。说明正常成人大腿近段坐骨神经的弥散张量成像及经纤维束示踪是可行的,可清晰显示坐骨神经走行及弥散特征;最佳b值为1200s/mm2。     

运动训练对坐骨神经损伤小鼠神经形态和功能恢复影响的研究

目的:观察运动训练对坐骨神经损伤小鼠神经形态和功能恢复的影响。方法:雄性昆明小鼠120只,随机分为对照组、假手术组、损伤模型组和损伤后水中运动训练组。采用右侧坐骨神经卡压模型,观察运动训练对小鼠爬网漏脚率、神经传导速度、神经髓鞘计数和神经形态的影响。结果:运动训练组小鼠术后3周爬网漏脚率明显低于损伤模型组(P0.01),术后3、4周神经传导速度也明显快于损伤模型组(P0.01,P0.05),神经髓鞘计数明显高于损伤模型组(P0.01),电镜下损伤神经得到修复,细胞形态基本恢复正常,明显好于损伤模型组。结论:运动训练可促进坐骨神经损伤小鼠的神经修复和功能恢复。     

坐骨神经震荡伤后腰髓背根神经节病理改变及意义

目的　应用图像分析和免疫组织化学技术观察和分析兔坐骨神经高速弹丸震荡伤后腰髓背根神经节病理改变及意义。方法　大耳白兔 2 5只 (包括正常对照 5只 ) ,致伤靶点为右后肢外侧坐骨神经体表投影线中点 (0 38g钢珠 ,0 6 5g装药量 ) ,观察伤后 1、3、7、14d(n =5 )腰髓背根神经节病理改变及一氧化氮合酶 (nitricoxidesynthase ,NOS)表达变化 (免疫组化法 ) ,并进行神经元计数及神经元截面积图像分析。结果　腰髓背根神经节伤后发生出血、水肿、神经元皱缩、坏死等变化 ,伤后 3dNOS表达显著增强 ,伤后 7d神经元数显著减少 ,神经元平均截面积显著减少。结论　坐骨神经高速弹丸震荡伤后腰髓背根神经节发生了较重的损伤。     

地塞米松对大鼠坐骨神经损伤后脊髓前角运动神经元CGRP的影响

目的：观察地塞米松对大鼠坐骨神经损伤后脊髓运动神经元降钙素基因相关肽（CGRP）的影响。方法：56只Wistar大鼠分为损伤组、地塞米松组（DSP组）及盐水组各16只,正常组8只。前3组大鼠均右侧股外侧切口,钳夹右侧坐骨神经造成神经损伤模型。造模成功后即刻DSP组局部肌肉间隙内注射DSP0．5mg／kg,每日1次;盐水组注射等量生理盐水,均4周;损伤组及正常组不做任何处理。利用免疫组织化学技术检测脊髓前角运动神经元内CGRP的变化。结果：造模术后各时间段比较,DSP组脊髓运动神经元CGRP的表达均高于其它各组（P〈0．01）。结论：DSP促进坐骨神经损伤后脊髓前角运动神经元内CGRP的表达增强,可能是其促进神经元修复的重要途径之一。     

Does antidromic activation of nociceptors play a role in sciatic radicular pain?

We describe a case where transcutaneous electrical stimulation of the right sciatic nerve in a patient with right L5 radiculopathy reproduced the patient's pathological pain in the leg. Following a right ankle block with 0.5% bupivacaine, the sciatic nerve stimulation induced pain in the thigh and the calf but not in the foot. Despite an increase in the magnitude of stimulation by 50% (compared with the stimulation before the block) the pain was not perceived below the level of blockade. We suggest that in this case the electrical stimulation generated impulses propagated antidromically into the leg and activated nociceptors in it. The bupivacaine blockade prevented antidromic propagation of impulses into the foot, therefore pain in this region was not perceived.     

Effect of Extracorporeal Shock Wave Therapy on Denervation Atrophy and Function Caused by Sciatic Nerve Injury

[Purpose] The present study examined the effects of treatment using extracorporeal shock wave therapy (ESWT) on the muscle weight and function of the hind limb in sciatic nerve injury. [Subjects] Forty rats with sciatic nerve crushing injury were randomly divided into two groups: an ESWT group (n=20), and a control group (n=20). [Methods] The ESWT group received extracorporeal shock wave treatment, and the control group did not receive any treatment after injury. Experimental animals were measured for muscle weight on an electronic scale and were tested for function on a sciatic functional index (SFI). [Results] All groups showed significant increases in the weights of the left soleus and gastrocnemius muscles, and decreases in the weights of the right soleus and gastrocnemius muscles (p<0.05). Comparison of SFI scores and muscle weights between the groups showed significant differences in SFI scores, and the right soleus and gastrocnemius muscles (p<0.05) [Conclusion] Exercise programs that use ESWT can be said to be effective at improving the function of the sciatic nerve and preventing the denervation atrophy.Key words: ESWT, Sciatic nerve, Peripheral nerve     

苏木乙醇提取物对坐骨神经损伤小鼠血清髓鞘碱性蛋白含量及神经功能的影响

目的研究苏木乙醇提取物(SME)对坐骨神经损伤小鼠神经再生的影响。方法选取成年雄性Balb/c小鼠84只,随机分为SME高中低剂量组和空白对照组,行右侧坐骨神经离断吻合术,分别于术后3、5天1、2、4、8、12周以ELISA法血清髓鞘碱性蛋白浓度,术后4、8、12周行神经电生理检测,将所得结果进行统计学分析。结果各时间点动物的血清髓鞘碱性蛋白浓度及电生理检测结果与SME剂量呈现明确的量效对应关系。结论SME可以通过抑制损伤后的免疫反应,降低神经损伤局部神经的破坏程度,从而加速神经再生。     

神经预变性促进周围神经桥接后神经再生的初步研究

目的探讨经过体内预变性的神经用于周围神经缺损桥接修复的效果。方法 SD大鼠20只,制作右侧坐骨神经压榨伤动物模型,3 d后,取坐骨神经用于对侧行神经桥接,在桥接后0 d、3 d、7 d、14 d取材,应用ED1和NF200染色比较双侧神经再生速度及神经纤维内巨噬细胞浸入情况。结果压榨伤后3 d,远端神经纤维内见大量ED1染色阳性巨噬细胞侵入,NF200阳性染色成棒状或碎片状;神经桥接后3 d、7 d、14 d,预变性组与对照组桥接远端均可见大量ED1染色阳性巨噬细胞侵入,经过预变性的神经内神经再生速度明显提高。结论 经过体内预变性的神经用于周围神经缺损桥接修复可明显促进神经再生,其机制可能是巨噬细胞的早期侵入,有利于神经生长抑制物的清除。     

High-frequency transcutaneous electrical nerve stimulation reduces pain and cardio-respiratory parameters in an animal model of acute pain: Participation of peripheral serotonin

The objective of this study was to investigate the effect of high-frequency transcutaneous electrical nerve stimulation (HF-TENS) in antihyperalgesia, assessed through changes of sciatic nerve activity and its effects on cardiorespiratory parameters, using formalin-induced nociception in anesthetized rats. The animals were divided into formalin (FORM) and HF-TENS groups. All rats received injections of 5% formalin (50 μl, right hind-paw). The sciatic nerve activity and cardiopulmonary parameters (mean arterial pressure, heart rate, and respiratory frequency) were measured, and then the serum levels of serotonin (5-HT) were determined by an enzyme-linked immunosorbent assay kit. The formalin injection was able to increase the sciatic nerve activity, heart rate, and respiratory frequency. The treatment with HF-TENS significantly reduced the sciatic nerve activity and respiratory frequency 20 minutes after formalin injection and was able to increase serum 5-HT. Furthermore, when comparing the groups, reductions in the mean arterial pressure, heart rate, respiratory frequency, and sciatic nerve activity were shown at different times. Thus, we concluded that HF-TENS was capable of inducing analgesia, which was most likely related to increased serotonin release. Moreover, we demonstrated that TENS was able to block the adverse cardiovascular and respiratory changes induced by pain. Further neurophysiological studies are necessary to clarify the intrinsic mechanisms underlying HF-TENS-induced analgesia.     

兔坐骨神经急性牵拉伤模型的制作:MRI与病理对照

目的 模拟人类周围神经牵拉伤机制,通过MRI与病理对照,探讨兔坐骨神经牵拉伤模型的制作。 方法 20只新西兰大白兔,随机选取一侧坐骨神经,使用无齿钳牵拉神经制作牵拉伤。每只兔在术前及牵拉伤后第3天均行双侧坐骨神经MRI,检查序列包括3D T2WI、T1WI、3D T2WI/SPIR、Mixed多回波序列(测量T1值)及SE多回波序列(测量T2值),并进行病理检查及后肢功能的评价。 结果 兔坐骨神经牵拉伤后,牵拉侧后肢运动功能及神经反射功能出现障碍,T2WI及T2WI/SPIR序列坐骨神经增粗,信号增高。损伤后与损伤前相比,牵拉近段、牵拉段、牵拉远段神经的T1值及T2值均升高,差异有统计学意义(P<0.05)。牵拉伤神经病理表现为髓鞘崩解、轴突丧失。结论 兔坐骨神经牵拉伤后MRI表现为神经增粗,T1、T2时间延长,通过病理对照,模型制作成功。