股骨髁上闭合性骨折合并坐骨神经损伤的治疗-中华神经创伤.PDF

·24 · 中华神经创伤外科电子杂志2015年4月第 1卷第2期 ChinJNeurotraumaSurg(ElectronicEdition),April2015,Vol.1,No.2 ·临床研究· 股骨髁上闭合性骨折合并坐骨神经 损伤的治疗 王文 李秉胜 刘立峰 张永先 王平山 曹学成 【摘要】 目的 探讨股骨髁上闭合性骨折合并坐骨神经损伤的创伤机制及治疗。 方法 选择自济南军区总医院骨创伤科2000 年1月至2014 年6 月收治的股骨髁上骨折患者316 例，分析 本组共15例股骨髁上闭合性骨折合并坐骨神经损伤患者病情，并行手术治疗，采用复位固定术，坐 骨神经探查，神经松解减压或束膜吻合，临床随访采用神经功能愈合标准(MCRR)进行恢复情况评 估。 结果 本组15例患者术前肌电图检查结果表现为：9 例患者神经传导速度轻度减慢、电位波 幅轻度降低、潜伏期轻度延长者；其中8 例患者术后随访神经恢复优4 例，良3 例，可1例。6 例患者 术前肌电图提示神经传导速度明显减慢、电位波幅明显降低、潜伏期明显延长。临床随访6 个月~3 年，按肌电图检查结果分组进行MCRR 标准评分的结果，坐骨神经恢复情况：优6 例，良4 例，可3 例，差2 例。 结论 肌电图检查结合术中肉眼观察坐骨神经损伤程度对指导手术和判断预后有 一定意义。 【关键词】 股骨骨折； 闭合性骨折； 坐骨神经； 损伤 Treatment of closed supracondylar femoral fracture complicated with sciatic nerve injury Wang Wen, Li Bingsheng, Liu Lifeng, Zhang Yongxian, Wang Pingshan, Cao Xuecheng. Department of Bone Traumatology, Jinan Military General Hospital, Jinan 250013, China Corresponding author: Wang Wen, Email: wangwen007@163.com 【Abstract 】 Objective To investigate the mechanism and treatment of supracondylar femoral closed fracture associated with sciatic nerve injury. Methods 15 cases of supracondylar femoral closed fracture associated with sciatic nerve injury patients underwent surgical treatment. The fracture was taken reposition and fixation, sciatic nerve exploration, nerve decompression or fascicular suture. Results The occurrence of excellent nerve recovery was 6 cases, fair recovery was 4 cases, poor recovery was 3 cases, bad recovery was 2 cases. Conclusions Patients with supracondylar femoral closed fracture associated with sciatic nerve injury should underwent the surgery as soon as possible, with the operation of fracture reposition and fixation, sciatic nerve exploration, nerve decompression or fascicular suture, in order to obtain a better outcome. It has a positive effect in operation and prognosis on the electromyography with intraope