sciatic nerve injury
Introduction
Introduction to sciatic nerve injury The sciatic nerve is composed of the lumbar medulla 4, 5 and the medulla, 1, 2, and 3 nerve roots. Causes of injury: mostly caused by femoral or hip firearm injuries, sometimes hip dislocation and pelvic fracture can also be combined with sciatic nerve injury. Drug-induced injury is not uncommon. When the fracture is complete, the muscles below the knee are full, but the hamstring muscle generally has little effect. If it is part of the injury, it is a part of the common peroneal or phrenic nerve. It is often necessary to loosen the nerve extensively and bend the knee and over-extension of the hip joint to suture. Postoperatively fixed at the above position for 6 to 8 weeks. Repairing nerves is of great significance for restoring sensation and nutrition, and can prevent ulcers. The sciatic nerve consists of the phrenic nerve and the common peroneal nerve, which originate from the anterior and posterior femores of the lumbar 4, 5, and iliac 1-3, and are enclosed in a connective tissue sheath. Wear the piriform muscle to the buttocks, descending the gluteus maximus along the midpoint of the greater trochanter and the ischial tuberosity, the posterior part of the femoral arm between the biceps muscle and the semimembranosus, and the tip of the axilla is divided into the sacral nerve And the common peroneal nerve, branching the biceps, semitendinosus and semimembranosus at the posterior part of the femoral branch. The performance after injury depends on the plane of the injury. basic knowledge The proportion of illness: 0.05%, more common in car accidents Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Cause of sciatic nerve injury
Drug factors (23%):
Drug injection injury, especially injection of penicillin, is the most common cause of sciatic nerve injury, also known as iatrogenic sciatic nerve injury, which occurs in children. The cause of injury is related to improper direct injury of the injection site or the dose of the drug is too large to stimulate the sciatic nerve.
Trauma factors (30%):
Sharp injuries, acetabular fractures, pelvic fractures, and hip dislocations, especially posterior dislocations, are also common causes of sciatic nerve injury.
Self-factor (25%):
Posterior dislocation of the hip, hip knife injury, gluteal muscle contracture injury, and intramuscular injection of the hip can cause high damage.
Pathophysiology
Posterior hip dislocation, hip knife injury, gluteal muscle contracture injury, and hip muscle injection can cause high-level injury, causing all muscles in the posterior part of the femur and calves and feet to be paralyzed, resulting in knee flexion, ankle joint and The toe motor function is completely lost and the foot is drooping. The posterior lateral and foot sensation of the calf is lost and neurotrophic changes occur in the foot. Because the quadriceps tendon is full, the knee joint is in a straight state, and it walks across the gait. If the middle and lower parts of the femur are damaged, the hamstring muscle is normal and the knee flexion function is preserved.
Prevention
Sciatic nerve injury prevention
Many patients with sciatica can clearly state that the onset is related to a sudden spiral of the waist, such as when lifting a heavy object, lifting a heavy object, bending over for a long time, or falling. Therefore, before the sudden weight-bearing action is required, the waist should be moved in advance to avoid spins in the waist. In general, the exercise of strengthening the lumbar muscles and improving the damp living environment can often reduce the incidence of the disease. Patients with this disease should seek medical treatment in time, rest in bed, and closely cooperate with Chinese medicine treatment.
Complication
Sciatic nerve injury complications Complication
The soles of the feet often have ulcers.
Symptom
Symptoms of sciatic nerve injury Common symptoms Outside the calf and the back of the foot... Below the thigh or knee... Retracting from the tail pain
Posterior hip dislocation, hip knife injury, gluteal muscle contracture injury, and hip muscle injection can cause high-level injury, causing all muscles in the posterior part of the femur and calves and feet to be paralyzed, resulting in knee flexion, ankle joint and The toe motor function is completely lost and the foot is drooping. The posterior lateral and foot sensation of the calf is lost and neurotrophic changes occur in the foot. Because the quadriceps tendon is full, the knee joint is in a straight state, and it walks across the gait. If the middle and lower parts of the femur are damaged, the hamstring muscle is normal and the knee flexion function is preserved.
1. Exercise: If the injury site is above the large ischial bone or the ischial tuberosity, the posterior femoral muscle group, the front, the outer and the back muscles of the calf and the muscles of the foot are all paralyzed, such as the injury in the lower part of the thigh, due to the reins The muscles of the muscles have been mostly emitted, and only the muscles below the knee are expressed. For example, the branches of the muscles are the tendons of the common peroneal nerve and the sacral nerve.
2. Feeling : Except for the saphenous nerve innervation area on the inner side of the calf and the medial malleolus, the area below the knee disappeared.
3. Nutrition : There are often severe nutritional changes, and there are often deep ulcers on the soles of the feet.
Examine
Sciatic nerve injury examination
Electrophysiological examination: typical neuroelectrophysiological manifestations are that the nerve conduction velocity of the affected side is slowed down, the amplitude is decreased, and the latency of F wave or H reflection is prolonged; the latency of somatosensory evoked potential (SEP) is prolonged, the amplitude is decreased, and the wave interval is prolonged; The electromyography of the sciatic nerve innervation muscle is mostly denervic potential, while the healthy side is normal, and there is no abnormality in the myoelectricogram of the quadriceps muscle in the affected side. The slightly stronger knee reflex is also related to the normal function of the muscle and the weakening of the antagonistic muscle function. These manifestations help to identify Guillain-Barré syndrome and polio.
Diagnosis
Diagnosis and diagnosis of sciatic nerve injury
History of trauma or history of injection, muscle spasm below the thigh or below the knee; muscle spasm in the branch of the nerve branch, partial loss of the area below the calf, EMG can confirm the diagnosis.
Generally not confused with other diseases.
