全髋关节置换致坐骨神经损伤:1例报告和综述

Sciatic nerve injury secondary to total hip arthroplasty: a case report and literature review

摘要:

坐骨神经损伤是全髋关节置换术后少见的并发症之一，造成神经损伤的原因包括术中对神经的直接损伤、肢体延长、骨水泥相关热损伤、术后血肿等。尽管已知这些常见的病因，仍有一半的神经损伤无法明确病因。虽然有较多的危险因素被先后报道，然而没有单一的一项被认为是最显著的危险因素。积极的手术探查、神经松解能改善神经功能，保守治疗适用于一部分明确无器质性病因的患者。坐骨神经损伤的预后往往无法预测，对于哪些因素可以决定这种损伤的演变并没有达成共识。本文报道1 例全髋关节置换导致坐骨神经损伤的临床资料，并对其病因、危险因素、治疗和预后进行文献综述。

Abstract:

Sciatic nerve injury is one of the rare complications secondary to total hip arthroplasty, which might be caused by direct in-traoperative nerve injury, limb elongation, bone cement-related heat injury, and postoperative hematoma. Despite abovementioned commoncauses, half cases of the nerve injuries might have no clear reason. Although a number of risk factors have been reported, no single one isconsidered the most significant risk factor. Active surgical exploration and neurolysis can improve nerve function, and conservative treat-ment is suitable for some patients with no definite organic cause. The prognosis of sciatic nerve injury is often unpredictable, and there is noconsensus on what factors can determine the evolution of this injury. This paper reports a case of sciatic nerve injury secondary to total hiparthroplasty, and reviews the literatures regarding its etiology, risk factor, treatment and prognosis.