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目的 探讨霰弹枪致坐骨神经损伤的临床特点及手术治疗方法、效果。 方法 19例坐骨神经霰弹枪伤中 ,臀部损伤 2例 ,大腿部损伤 14例 ,窝部损伤 3例。枪伤射击距离在 0 5～9 0m之间 ,按霰弹枪的Shermen分型划分 ,Ⅰ型 4例 ,Ⅱ型 11例 ,Ⅲ型 4例。伤后至入院手术时间除1例为 4h外 ,其余均为 2～ 14个月。 1例行清创、神经外膜对端吻合术 ,7例行神经全干移值术 ,6例行神经电缆式移植 ,4例行神经松解术 ,1例行踝关节融合术。 结果 19例患者随访 0 8～ 3 5年、平均 19个月 ,根据英国医学研究院神经外科学会制定的MCRR标准 ,坐骨神经损伤恢复的优良率为5 2 6 %。 结论 坐骨神经霰弹枪伤的伤情复杂 ,常合并开放骨折、血管损伤、软组织缺损及感染 ;神经损伤的性质多为Sunderland分度中的 4～ 5度损伤 ;手术治疗方法以神经移植为主 ,但预后不佳 ;神经损伤后应给予正确的初始治疗 ,在对损伤神经恢复状况认真的连续、动态观察的基础上 ,正确评估神经损伤性质 ,采取积极、恰当的手术治疗 ,同时注重神经营养药物、康复理疗等综合治疗 ,才能获得较好的手术效果。
Objective To investigate the clinical characteristics of sciatic nerve caused by shotgun and surgical treatment methods and effects. Methods Nineteen cases of sciatic shotgun injuries were treated with 2 cases of hip injury, 14 cases of thigh injury and 3 cases of popliteal injury. Gunshot wound range of 0 5 ~ 9 0m, according to the Shermen classification of the shotgun division, Ⅰ type in 4 cases, Ⅱ type in 11 cases, Ⅲ type in 4 cases. Injury to hospital admission time except 1 case of 4h, the rest are 2 to 14 months. One patient underwent debridement and epineurial end-to-end anastomosis. Seven patients underwent total nerve allograft operation. Six patients underwent nerve cable transplantation. Four patients underwent neurolysis and one patient underwent ankle arthrodesis. Results 19 patients were followed up from 08 to 35 years with an average of 19 months. According to the MCRR standard set by the Institute of Neurosurgery, British Academy of Medical Sciences, the excellent and good rate of sciatic nerve injury recovery was 52.6%. Conclusions Sciatic nerve shotgun injuries are complicated and often accompanied by open fractures, vascular injuries, soft tissue defects and infections. The nature of the nerve injury is mostly 4-5 degrees in the Sunderland scale. The surgical treatment is mainly based on nerve grafts. However, Poor prognosis; nerve injury should be given the correct initial treatment, the serious injury in the recovery of nerve status based on continuous, dynamic observation of the correct assessment of the nature of nerve injury, take a positive and appropriate surgical treatment, while focusing on neurotrophic drugs, Rehabilitation physiotherapy and other comprehensive treatment, in order to obtain better surgical results.