髋臼骨折合并坐骨神经损伤的治疗

摘要

Objective:To investigate the effect of treatment for acetabular fractures complicated with sciatic nerve injuries .Methods:53 cases of acetabular fractures complicated with sciatic nerve injuries were reviewed .39 cases were treated by operation , the fracture were reducted and fixed with steel plates and screws , the sciatic nerves were neurolysis or nerve repair;14 cases were treated with non surgical methods.35 cases of surgical group and 12 cases of non surgical group were followed , The follow-up period lasted from 1 year to 8 years with an average of 2 years.Results:The outcome of sciatic nerve was evaluated according to MCRR criteria , of 35 cases surgical group , 19 were excellent,10 good, 5 fair,1 poor;of 12 non surgical group, 5 excellent,2 good,3 fair,2 poor.The fractures were evaluated according to Matta criteria, of 35 cases surgical group ,21 good,14 fair, 0 poor;Of 12 non surgical group , 2 good, 6 fair, 4 poor.Conclusion:Early reduction and fixation of the fractures and early exploration of the sciatic nerve and neurolysis or repairing of the injured sciatic nerve may contribute to good prognosis .%目的：探讨髋臼骨折合并坐骨神经损伤患者的治疗方法及疗效。方法：对53例髋臼骨折合并坐骨神经损伤患者进行回顾性分析，其中39例行手术治疗，将骨折复位、固定，坐骨神经探查，神经松解减压或束膜吻合；14例行保守治疗，给予牵引，营养神经，理疗等。获得随访47例，手术组35例，保守治疗组12例。随访12个月～8年，平均2年。结果：坐骨神经损伤功能恢复情况根据MCRR标准，手术治疗组，优19例，良10例，一般5例，差1例；保守治疗组，优5例，良2例，一般3例，差2例。髋臼骨折复位程度按Matta标准，手术组解剖复位为21例，满意复位为14例，不满意复位0例；保守组解剖复位为2例，满意复位为6例，不满意复位4例。结论：髋臼骨折合并坐骨神经损伤者应早期手术，将骨折复位、固定，坐骨神经探查，神经松解减压或束膜吻合，可获得较好疗效。