30例髋关节骨折脱位合并坐骨神经损伤的临床疗效分析

目的分析髋关节骨折脱位合并坐骨神经损伤患者的临床效果。方法 2001年1月至2007年6月收治30例髋关节骨折脱位合并坐骨神经损伤,均接受坐骨神经探查术,选Kocher-Langenbeck(KL)切口,其中5例加用髂腹股沟入路,髋臼骨折应用髋臼钢板及松质骨螺钉固定治疗。手术方法包括:神经松解术与神经吻合术。结果坐骨神经功能恢复评定按Sunderland标准,术后的坐骨神经功能恢复(优7例,良8例,可8例,差7例)较术前(优0例,良4例,可12例,差14例)显著改善,差异有统计学意义(P<0.01)。胫神经损伤与腓总神经损伤术后神经传导速度分别为(41.26±2.49)mm/s与(36.78±2.68)mm/s,较术前的(35.06±2.08)mm/s、(30.32±2.30)mm/s显著改善,差异有统计学意义(P<0.01)。结论手术治疗是髋关节骨折脱位合并坐骨神经损伤的有效方法,手术入路首选KL入路。

Analysis on the clinical treatment 30 cases of hip fracture-dislocation combined sciatic nerve injury

Objective To analyze the clinical operation treatment methods of hip fracture-dislocation combined sciatic nerve injury.Methods 30 cases of hip fracture-dislocation and combined sciatic nerve injury taken operation were chosen out for study and took sciatic nerve exploration surgery.Kocher-Langenbeck(KL) incision were chosen out,among which 5 cases were combined with ilioinguinal approach.Acetabular fractures should take fixation treatment with acetabular bone plates and screws.Operation methods included neural lysis and nerve anastomosis.Results Nerve function recovery was assessed by Sunderland.After operation,recovery of neurological function(excellent 7 cases,good 8 cases,yes 8 cases,poor 7 cases) was significantly improved than before operation(excellent 0 cases,good 4 cases,yes 12 cases,poor 14 cases)(P<0.01).Nerve conduction velocity after tibial nerve injury and peroneal nerve injury operation were 41.26±2.49 mm/s and 36.78±2.68 mm/s,which were significantly improved than that before operation(35.06±2.08 mm/s,30.32±2.30 mm/s)(P<0.01).Conclusion Operation is an useful method to treat hip fracture-dislocation combined sciatic nerve injury.Surgical approach should choose Kocher-Langenbeck firstly.