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190例臀部坐骨神经损伤 ,其中药物注射伤 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。据 175例手术所见 ,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 ,神经外膜对端吻合术 12例 ,神经移植术 2例 ,神经探查未修复神经 1例 ,非手术治疗 15例。 2 3例作了后期足踝部功能重建术。结果 ,15 1例随访 0 5～ 2 1年 (平均 8年 6月 ) ,神经恢复的优良率为 5 6 96 % ,后期功能重建的优良率为 78 2 5 %。结果提示 ,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作神经松解术 ;神经断裂伤作外膜对端吻合术 ;骨盆骨折、髋脱位引起者 ,早期复位减压 ,后期探查修复神经。盆腔出口处损伤 ,有可能克服 4～ 5cm以下缺损作神经对端吻合术。足踝部功能重建可改善肢体功能
190 cases of hip sciatic nerve injury, of which 16 4 cases of drug injection (86 32%), sharp injury in 14 cases, pelvic fracture, hip joint dislocation and injury in 11 cases, hip contusion in 1 case. According to 175 surgical findings, the injury plane in the gluteus maximus 146 cases, 26 cases of piriformis, pelvic segment in 3 cases. There were 160 cases of neurolysis, 12 cases of epineurium end-to-end anastomosis, 2 cases of nerve grafting, 1 case of nerve exploration without repair and 15 cases of non-surgical treatment. Twenty-three patients underwent functional ankle reconstruction surgery. Results 15 1 cases were followed up for 0 ~ 51 years (mean 8 years in June). The excellent and good rate of neurological recovery was 56 96%. The excellent and good rate of postoperative functional reconstruction was 78 25%. The results suggest that the injury of the sciatic nerve in the buttocks is one of the most difficult and ineffective parts of peripheral nerve injury. The injury of each segment is closely related to the local anatomy. Treatment should hold a positive attitude, drug injection should strive for as soon as possible for neurological release injury; nerve rupture injury for end to end anastomosis; pelvic fracture, hip dislocation caused by early reduction and decompression, late exploration repair nerve. Pelvic outlet injury, it is possible to overcome the 4 ~ 5cm defect for nerve end to end anastomosis. Functional reconstruction of the foot and ankle improves limb function