PDF(Pubmed)
Abstract：
The obturator nerve originates from the lumbar plexus and innervates sensation in the thigh and movement of the adductor muscle group of the hip. Reports on physical therapy for patients with obturator nerve injuries have been limited due to insufficient injuries, and there have been no reports on rehabilitation after neurotmesis. Furthermore, there are no reports on the status of activities of daily living (ADL) and details of physical therapy in patients with paralysis of the adductor muscle group. In this study, we reported on a patient with adductor paralysis due to obturator neurotmesis, including the clinical symptoms, characteristics of ADL impairment, and effective movement instruction. The patient is a woman in her 40\'s who underwent laparoscopic total hysterectomy, bilateral adnexectomy, and pelvic lymph node dissection for uterine cancer (grade-2 endometrial carcinoma). During pelvic lymph node dissection, she developed an obturator nerve injury. She underwent nerve grafting during the same surgery by the microsurgeon. Donor nerve was the ipsilateral sural nerve with a 3-cm graft length. Due to obturator nerve palsy, postoperative manual muscle test results were as follows: adductor magnus muscle, 1; pectineus muscle, 1; adductor longs muscle, 0; adductor brevis muscle, 0; and gracilis muscle, 0. On postoperative day 6, the patient could independently perform ADL; however, she was at risk of falling toward the affected side when putting on and taking off her shoes while standing on the affected leg. The patient was discharged on postoperative day 8. Through this case, we clarified the ADL impairment of a patient with adductor muscle palsy following obturator neurotmesis, and motion instruction was effective as physical therapy for this disability. This case suggests that movement instruction is important for acute rehabilitation therapy for patients with hip adductor muscle group with obturator neurotmesis.
摘要：
闭孔神经起源于腰丛，支配大腿的感觉和髋关节内收肌群的运动。关于闭孔神经损伤患者的物理治疗的报道由于损伤不足而受到限制，也没有关于神经注射后康复的报道。此外，没有关于内收肌组瘫痪患者日常生活活动(ADL)状况和物理治疗细节的报告.在这项研究中,我们报道了一名闭孔神经阻塞导致内收肌麻痹的患者，包括临床症状，ADL损害的特征，和有效的运动指导。患者是一名40多岁的女性，接受了腹腔镜全子宫切除术，双侧附件切除术，子宫癌（2级子宫内膜癌）的盆腔淋巴结清扫。在盆腔淋巴结清扫术中，她出现闭孔神经损伤.她在显微外科医生的同一手术中接受了神经移植。供体神经是同侧腓肠神经，移植物长度为3厘米。由于闭孔神经麻痹,术后手法肌肉检查结果如下:大肌内收肌,1；果胶肌，1；内收肌长肌，0；短收肌，0；和股薄肌，0.在术后第6天，患者可以独立进行ADL;然而，当她站在受影响的腿上穿鞋和脱鞋时，她有向受影响的一侧摔倒的危险。患者在术后第8天出院。通过这个案子,我们阐明了闭孔神经阻滞后内收肌麻痹患者的ADL损害，和运动指导是有效的物理治疗这种残疾。这种情况表明，运动指导对于患有闭孔神经阻塞的髋关节内收肌群患者的急性康复治疗很重要。
