骨盆骨折医原性神经损伤的机制及防治资料分析

目的探讨骨盆骨折医原性神经损伤的机制及预防的相关因素。方法分析骨盆骨折神经损伤中的医原性神经损伤共12例,其中男8例,女4例。所有12例均实施手术治疗,1例入院非手术治疗6 d后出现股外侧皮神经损伤,11例于术后出现神经损伤。确诊神经损伤后,及时行神经营养药物及针灸、康复理疗等综合治疗。结果 11例获随访,随访时间3个月至2年,平均1.4年。感觉功能完全康复9例(优,占90%),部分康复1例(良,占10%);运动功能完全康复8例(优,占88%),部分康复1例(良,占12%);直肠/膀胱功能2例均完全康复(优,占100%)。结论术中神经损伤是骨盆骨折医原性神经损伤最主要的原因,最容易损伤的神经为腰骶神经,其次为股外侧皮神经、坐骨神经、臀上神经和股神经。提高对骨盆神经应用解剖的认识,注意手术操作,可以有效避免医原性神经损伤的发生。

Mechanism of the iatrogenic nerve injuries in pelvis fracture and its related prevention & treatment data analysis

Objective To study the mechanism and relative prevention of the iatrogenic nerve injuries in pelvis fracture.Method The 12 patients with iatrogenic nerve injuries in pelvis fracture were treated and analyzed,including 8 males and 4 females.Among all the 12 patients who were operated on,there were one case of lateral femoral cutaneous nerve injury occured after conservative treatment,11 cases of iatrogenic nerve injuries after surgery.After nerve injury,the measures had been taken,include neurotrophic drugs,acupuncture,physiotherapy and other comprehensive treatment.Result Only 11 cases were followed up.The follow-up period lasted from 3 months to 2 years with an average of 1.4 years.The nerve sensory function recovered excellently in 9 cases,good in 1 case;the nerve motor function recovered excellently in 8 cases,good in 1 case.The nerve rectum and bladder function recovered excellently in all 2 cases.Conclusion Nerve injury during operation is the main reason of iatrogenic nerve injuries in pelvis fracture.lumbosacral nerve is the most one to be damaged easily,followed by lateral femoral cutaneous nerve,sciatic nerve,superior gluteal nerve and femoral nerve.Iatrogenic nerve injury recovered well.Raise the awareness of applied anatomy of the pelvic nerve and the attention to surgical procedures can effectively avoid the occurrence of iatrogenic nerve injury.