儿童注射性坐骨神经损伤手术治疗疗效分析.DOCVIP

临床医学论文-儿童注射性坐骨神经损伤手术治疗疗效分析 ?［摘 要］ 目的? 分析手术治疗儿童注射性坐骨神经损伤的疗效，探讨早期手术对肌肉注射性儿童坐骨神经损伤的恢复是否更为有利。 方法? 回顾性总结分析由肌肉注射引起的坐骨神经损伤患儿45例，观察在不同时期内采用神经卡压松解手术后恢复情况，并分析探讨肌肉注射导致坐骨神经损伤的机制和临床特点。 结果? 坐骨神经损伤患儿45例，伤后3周内行手术治疗33例，完全恢复31例;伤后3～12周内手术11例，完全恢复1例，基本恢复8例;伤后12周手术1例，未完全恢复。 结论? 注射性坐骨神经损伤一旦有损伤的症状和体征，应早期手术治疗，及早神经外膜松解，对于神经功能的恢复有积极意义。 ??? ［关键词］ 坐骨神经损伤;肌肉注射;手术 ? ??? Abstract:Objective To assess the therapeutic effect of surgical treatment for sciatic nerve injury casused by intramuscular injection in chil-dren and to clarify whether the surgical treatment should be performed as early as possible.Methods The recovery situation after surgical treatment performed at different period after sciatic nerve injury in57children was retrospectively analyzed.The mechanism of injury and clinical feature were also investigated.Results Among33cases received surgical treatment in3weeks after injury，31cases were of complete recovery;Among11cas-es received surgical treatment in3to12weeks after injury，1case was of complete recovery and8cases of obvious improvement;no case was of complete revovery after surgical treatment beyond12weeks after injury.Conclusion For the sciatic nerve injury caused by intramuscular injection in children，early operation is favourable. ????? Keywords:sciatic nerve injury;intramuscular injection;operation ??? 臀部肌肉注射引起坐骨神经损伤以儿童占大多数，是一种典型的医源性损伤，近年来常引起医疗纠纷。损伤后如何尽可能防止出现严重功能障碍和提高治疗效果，是值得注意的问题。作者自1992年以来收治45例注射性坐骨神经损伤病人采用手术治疗，效果良好。 ??? 1 资料与方法 ??? 1.1 临床资料 ??? 本组病例45例，男27例，女18例。年龄:1～3岁20例，3～6岁17例，6～12岁8例。原发疾患为上呼吸道感染36例，疖肿7例，外伤2例。注射药物为青霉素、庆大霉素，其中有28人一次注射剂量超过4mL。有明确的臀部肌肉注射史，表现为肌肉注射后立即出现臀部疼痛并向下肢放射，下肢不能行走，或3～5d内逐渐出现这些症状和体征。局部疼痛通过热敷及对症处理后一般在数小时内缓解，以后主要表现为足下垂或患儿不愿下地行走。本组中3例为完全性坐骨神经损伤，4例为不完全性坐骨神经损伤，27例为单纯腓总神经损伤，11例为单纯胫神经损伤。坐骨神经完全性损伤时膝以下肌肉全瘫，膝以下除小腿内侧隐神经支配区外感觉均消失。腓总神经损伤主要表现为踝关节及足趾不能背伸，因呈明显的足下垂，患侧足背及小腿外侧皮肤感觉减弱或消失。胫神经损伤主要表现为小腿后侧及足底感觉减弱或消失，足跖屈功能减弱或消失，晚期出现仰趾外翻畸形。患侧神经肌电图（EMG）检查证实为神经源性损伤，神经肌电图结果与临床症状体征相符。 ??? 1.2 手术方法 ??? 本组病例中:伤后1周内手术者15例;伤后1～3周内手术者18例;伤后4～8周内手术者7例;伤后8～12周内手术者4例;伤后12～24周内手术者1例。手术切口自