中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2013年
31期
17-19
,共3页
肌肉注射%坐骨神经%医源性损伤%解剖%外科手术
肌肉註射%坐骨神經%醫源性損傷%解剖%外科手術
기육주사%좌골신경%의원성손상%해부%외과수술
Intramuscular injection%Sciatic nerve%Iatrogenic injury%Anatomy%Surgical operation
目的：探讨臀部肌肉注射性坐骨神经损伤的发生机制及诊治方法，并结合15具尸体标本30条坐骨神经的解剖走行特点分析其损伤原因。方法：回顾性总结1995年10月-2012年10月本院收治的23例采用手术治疗的患者临床资料，观察治疗效果；并通过15具尸体标本和23例手术患者共53条坐骨神经归纳坐骨神经穿出梨状肌前后的分支类型，论述坐骨神经伤的医源性和解剖学原因。结果：（1）23例患者中，术后1周症状完全恢复4例，基本恢复7例；术后随访3个月：完全恢复11例，基本恢复6例，部分恢复6例；术后6个月：完全恢复16例，基本恢复5例，部分恢复2例，治愈率69.6%；（2）15具尸体30条坐骨神经对照组变异比例小于正常变异比例；23例坐骨神经损伤的病例中，有4例为Ⅰ型，1例为Ⅱ型，14例为Ⅲ型，4例为Ⅳ型，变异比例82.6%，且损伤者多为小儿。结论：注射性坐骨神经损伤不仅与注射操作不规范所致的机械刺激、药物毒性、瘢痕压迫有关，主要与坐骨神经的解剖学结构和走行变异有关。解剖学结构中小儿臀大肌发育差、臀部小和坐骨神经走行变异是其注射性损伤的物质基础；外科治疗是坐骨神经损伤修复的有效方法。
目的：探討臀部肌肉註射性坐骨神經損傷的髮生機製及診治方法，併結閤15具尸體標本30條坐骨神經的解剖走行特點分析其損傷原因。方法：迴顧性總結1995年10月-2012年10月本院收治的23例採用手術治療的患者臨床資料，觀察治療效果；併通過15具尸體標本和23例手術患者共53條坐骨神經歸納坐骨神經穿齣梨狀肌前後的分支類型，論述坐骨神經傷的醫源性和解剖學原因。結果：（1）23例患者中，術後1週癥狀完全恢複4例，基本恢複7例；術後隨訪3箇月：完全恢複11例，基本恢複6例，部分恢複6例；術後6箇月：完全恢複16例，基本恢複5例，部分恢複2例，治愈率69.6%；（2）15具尸體30條坐骨神經對照組變異比例小于正常變異比例；23例坐骨神經損傷的病例中，有4例為Ⅰ型，1例為Ⅱ型，14例為Ⅲ型，4例為Ⅳ型，變異比例82.6%，且損傷者多為小兒。結論：註射性坐骨神經損傷不僅與註射操作不規範所緻的機械刺激、藥物毒性、瘢痕壓迫有關，主要與坐骨神經的解剖學結構和走行變異有關。解剖學結構中小兒臀大肌髮育差、臀部小和坐骨神經走行變異是其註射性損傷的物質基礎；外科治療是坐骨神經損傷脩複的有效方法。
목적：탐토둔부기육주사성좌골신경손상적발생궤제급진치방법，병결합15구시체표본30조좌골신경적해부주행특점분석기손상원인。방법：회고성총결1995년10월-2012년10월본원수치적23례채용수술치료적환자림상자료，관찰치료효과；병통과15구시체표본화23례수술환자공53조좌골신경귀납좌골신경천출리상기전후적분지류형，논술좌골신경상적의원성화해부학원인。결과：（1）23례환자중，술후1주증상완전회복4례，기본회복7례；술후수방3개월：완전회복11례，기본회복6례，부분회복6례；술후6개월：완전회복16례，기본회복5례，부분회복2례，치유솔69.6%；（2）15구시체30조좌골신경대조조변이비례소우정상변이비례；23례좌골신경손상적병례중，유4례위Ⅰ형，1례위Ⅱ형，14례위Ⅲ형，4례위Ⅳ형，변이비례82.6%，차손상자다위소인。결론：주사성좌골신경손상불부여주사조작불규범소치적궤계자격、약물독성、반흔압박유관，주요여좌골신경적해부학결구화주행변이유관。해부학결구중소인둔대기발육차、둔부소화좌골신경주행변이시기주사성손상적물질기출；외과치료시좌골신경손상수복적유효방법。
Objective:To explore the pathogenesis and the diagnosis and treatment of gluteal muscle injection sciatic nerve injury,to combine with specimens of 15 bodies article 30 sciatic nerve anatomic characteristics analysis of the causes of injury. Method:The clinical data of 23 patients by operation treatment in our hospital in October 1995 to October 2012 were retrospectively analyzed,15 cadaver specimens and 23 patients a total of 53 sciatic nerve after sciatic nerve passes through the inductive branch type piriformis,discussed the reason of iatrogenic sciatic nerve injury and anatomy. Result:(1)Among the 23 cases,1 weeks after the operation,4 cases were completely recovered,7 cases of the basic recovery;After 3 months follow-up:11 cases completely recovered,restored in 6 cases,partial recovery in 6 cases;6 months after operation:complete recovery in 16 cases,the basic recovery in 5 cases,partial recovery in 2 cases,the cure rate was 69.6%;(2)The 15 bodies 30 sciatic nerve the control group was less than the normal variation ratio variation ratio;23 cases of sciatic nerve injury,4 cases of typeⅠ,1 cases typeⅡ,14 cases of typeⅢ,4 cases of typeⅣ,variation ratio of 82.6%,and the damage for more children. Conclusion:Injection of sitting bone nerve injury not only with the injection operation is not standard caused by mechanical stimulation,drug toxicity,scar oppression,main and sciatic anatomical structure of neural and walking variability. Difference,hips and sciatic nerve in children with gluteal muscle developmental anatomy structure in variation is the material base of injection injury;surgical therapy is an effective method for the repair of sciatic nerve injury.
