Surgical repair of sciatic nerve injuries: multi-centre study at Egypt
摘要
The sciatic nerve is long wide peripheral nerve and innervates the much of the lower limb muscles. Because of the long course of the sciatic nerve, many different causes and scenarios can cause its injury. Common causes of these injuries include road traffic accidents (RTA), hip joint dislocation, injection injuries, penetrating stap injuries and gunshot wounds (GSW). Also, according to the site of injury, the symptoms and signs differ and can be concluded at the following Gluteal region, upper thigh of thigh, mid-thigh and lower third of thigh. Most of the patients whose sciatic nerve injury, present with foot drop. According to the clinical picture and time of injury, different programs of physiotherapy and rehabilitation can be designed at the periods before and after the surgical interventions.
PurposeTo analyze and evaluate the interventional surgical treatment for the sciatic nerve injuries in patients who presented to our neurosurgery departments.
Study designRetrospective and prospective descriptive clinical study.
Patients and methodsThe study included 73 patients whose sciatic nerve injuries in-between January 2021 to January 2025, all of them presented at least with foot drop and underwent surgical treatment. They included 60 male patients and 13 female patients, mean age is 26.5 years, range 1 to 52 years. The causes of sciatic nerve injuries were as the following; closed blunt trauma in 29 patients, penetrating trauma in 15 patients, gunshot wound (GSW) in 13 patients, wrong intramuscular (IM) injection in 11 patients and following hip joint arthroplasty surgery in 5 patients. The peroneal nerve was included in all patients while both peroneal nerve and tibial nerve were included in 20 Patients. All patients were followed by rehabilitation and physiotherapy programs. Motor power of the ankle dorsi-flexion was assessed in regular way using the Motor research council (MRC) scale. The functional motor recovery was considered from grade 3 and more. The mean follow-up period was 9 months (range 6 to 12 months).
ResultsAll the patients had foot drop prior to the surgical intervention, the patients underwent surgical procedures as the following; neurolysis in 54 patients (80% of them showed functional motor recovery), direct surgical repair in 16 patients (75% of them showed functional motor recovery) and nerve grafting in 3 patients (all of them not show any functional recovery).
ConclusionEarly surgical microscopic intervention showing promising results with significant improvement of the dorsiflexion of ankle joint after sciatic nerve surgery, especially if the nerve required neurolysis rather than other surgical procedures.