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背景:人工全髋关节置换术(THR)是近年来治疗老年人髋关节疾患的首选方法,按Harri’s评分优良率为84%。该手术对坐骨神经损伤发生率国内报道为0.46%,国外报道为0.08%～9.70%。目的:通过解剖位置的分析探讨THR术中坐骨神经损伤的因素。设计:以人体解剖标本为研究对象,单一样本研究。单位:湖州师范学院医学院解剖实验室。对象:实验于2003-03/05在湖州师范学院医学院解剖实验室完成。正常人体成年骨盆标本56具,男27具,女29具。方法:对坐骨神经的来源及走行、坐骨神经与髋臼的关系进行测量分析,并对在THR术中拉钩及螺丝钉固定所致坐骨神经损伤,进行详尽测量分析。主要观察指标:坐骨神经与髋臼的位置关系。结果:测出坐骨神经至髋臼底的距离左侧为(6.00±0.85)mm,右侧为(6.00±0.71)mm;坐骨神经至髋臼缘的距离左侧为(13.00±0.75)mm,右侧为(14.00±0.06)mm。坐骨神经在髋臼缘处周径左侧为(32.00±0.28)mm,右侧为(31.00±0.68)mm。髋臼底至坐骨大孔的距离为左侧为(29.00±0.36)mm,右侧为(29.00±0.24)mm。结论:确定拉钩及螺丝钉固定在1～3点及5～6点为安全区。在THR术中陈旧髋臼骨折脱位、拉钩的位置不当、螺钉固定髋臼位置不当均可导致医源因素损伤坐骨神经。
Background: Artificial total hip arthroplasty (THR) is the first choice for the treatment of hip disorders in the elderly in recent years. According to Harri’s score, the excellent and good rate was 84%. The incidence of sciatic nerve injury in this report was 0.46% in China and 0.08% ~ 9.70% in foreign countries. Objective: To investigate the factors of sciatic nerve injury in THR by analyzing the anatomic location. Design: Human anatomical specimens for the study, a single sample study. Unit: Huzhou Teachers College Medical College Anatomy Laboratory. PARTICIPANTS: The experiment was performed at the Anatomy Laboratory of Huzhou Teachers College from 2003-03 / 05. Normal adult pelvis 56 specimens, 27 males and 29 females. Methods: The origin and course of sciatic nerve, the relationship between sciatic nerve and acetabulum were measured and analyzed, and the sciatic nerve injury caused by the hook and screw fixation in THR was analyzed. MAIN OUTCOME MEASURES: The relationship between sciatic nerve and acetabulum. RESULTS: The distance from the sciatic nerve to the acetabulum was (6.00 ± 0.85) mm on the left and (6.00 ± 0.71) mm on the right. The distance from the sciatic nerve to the acetabular rim was (13.00 ± 0.75) mm on the left and the right (14.00 ± 0.06) mm. The diameter of the sciatic nerve at the acetabular margin was (32.00 ± 0.28) mm on the left and (31.00 ± 0.68) mm on the right. The distance from the acetabulum to the ischial foramina was (29.00 ± 0.36) mm on the left and (29.00 ± 0.24) mm on the right. Conclusion: It is determined that the hook and the screw are fixed at 1 ~ 3 o’clock and 5 ~ 6 o’clock as safe area. In the THR surgery acetabular fractures and dislocations, the location of the hooks, improper screw placement of the acetabulum can lead to iatrogenic injury to the sciatic nerve.