摘要
目的探讨带背阔肌的胸背动脉血流桥接皮瓣重建前臂屈指及屈拇功能的方法及疗效。方法回顾性分析2011年3月至2013年2月治疗9例前臂损伤患者资料，男5例，女4例；年龄22-57岁，平均39．2岁；均为复合组织缺损；手指屈曲受限，创面最小为15cm×6cm，最大为21cm×9cm；移植皮瓣面积最小为17cm×7cm，最大为24cm×10cm。采用带背阔肌的胸背动脉皮瓣移植并桥接动脉缺损，将胸背动脉主干、远端分支分别与受区动脉近、远断端行端一端吻合；胸背动脉伴行静脉（7例为2支，2例为1支）与受区浅静脉（或伴行静脉）行端一端吻合；胸背神经与正中神经肌支行端一端吻合。术后6、12个月对移植肌肉行肌电图及屈肌抓力检查，对皮瓣外形及功能满意度行问卷调查，对患肢功能行Enneking评分。结果术后7例获得随访，随访时间12-24个月，患者对皮瓣外形及功能均满意。术后3个月移植肌肉可触及轻收缩，肌电图最大收缩呈单纯相；6个月时呈混合相，2—5指平均抓力为（8．97±2．91）g/mm^2,拇指与示指捏力为（1．39±0．22）g／mm^2；12个月时呈干扰相，2-5指平均抓力为（11．69±3．71）g／mm^2，拇指与示指捏力为（1．67±0．34）g／mm^2；运动神经功能检查与评定分级，4例M3^＋、3例M3；Enneking评分为正常侧65．7％±15．9％。结论吻合血管的带背阔肌的胸背动脉皮瓣可以通过血流桥接的方式移植，可恢复3级以上的屈指功能，并能重建肢体血运，是一种良好的肌肉功能重建术式。
Objective To investigate the clinical application of flow-through latissimus dorsi musculocutaneous flaps for functional reconstruction of musculus flexor digitorum defects. Methods 9 forearm traumatic patients were selected admitted from March 2011 to February 2013, aged 22 to 57 years old （average age 39.2）, including 5 male and 4 female. All cases were com- bined injuries. The flexion of the fingers was constrained. The injury areas ranged from 15 cm×6 cm to 21 cm×9 cm while the flaps were 17 cm×7 cm at least and 24 cm×l0 cm at most. For traumatic musculus flexor digitorum, skin, soft tissue and radial artery de- fects were all well repaired with functional flow-through latissimus dorsi musculocutaneous flaps. Functional exercise and physical therapy were done 3 weeks later. Electromyography, grip strength, and pinch strength evaluation were performed at the 6, 12 months after operating. Enneking evaluation was scored during follow-up periods from 12 to 24 months. All the results were mea- sured and evaluated. Results All flaps survived completely in 9 patients and recipient radial artery were bypassed well. The flaps had good appearance and high aesthetic satisfactory. Seven cases had more than 12 months＇ follow-up periods. Muscle con- traction can be touched 3 months after transplantion. Diagram of EMG tracing showed that the maximum voluntary contraction ac- tion potentials presented simple phase at 3 months, intermix phase at 6 months, and interference phase at 12 months. The average grip strength of the second to fifth finger was 8.97±2.91 g/mm^2 at 6 months, 11.69±3.71 g/mm^2 at 12 months. The average pinch strength of thumb and the index finger was 1.39±0.22 g/ram2 at 6 months, 1.67±0.34 g/mm^2 at 12 months. For the muscle power re- covery and motor nerve function scale, 4 cases were M3^＋, 3 cases were M3. The average ratio of Enneking evaluation score with nomal was 65.7%- 15.9%. Conclusion As functional musculocutaneous flaps, flow-through latissimus dorsi musculocutaneous flaps are effective for reconstruction of musculus flexor digitorum and wound defects. The vascular status of the extremities are pro- tected and maintained, which is extremely useful in forearm-salvage procedures from both functional and structural viewpoints.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第5期558-563,共6页
Chinese Journal of Orthopaedics
关键词
外科皮瓣
皮肤移植
动脉
Surgical flaps
Skin transplantation
Arteries
