三角肌软组织恶性肿瘤肌室切除背阔肌肌瓣转位重建肩外展功能的临床应用

Clinical Application of Reconstruction of Stability and Abduction Function of Shoulder Joint Using Latissimus-dorsi Muscle Flap Displacement after Muscle-group Resection of Malignant Tumor in Deltoid Muscle

目的:探讨三角肌内恶性肿瘤行肌室切除术,应用背阔肌肌瓣转位重建肩关节稳定性及外展功能,探讨其方法、应用的临床价值并评价其疗效。方法:回顾总结1999年1月～2004年8月三角肌软组织肉瘤病例8例,其中男性5例,女性3例;年龄25～64岁,平均44.5岁。左侧6例,右侧2例。病程6个月～3年,平均1年2个月。恶性纤维组织细胞瘤4例,滑膜肉瘤2例,,透明细胞肉瘤2例。术前、术后8例患者肩关节功能按MTST关节功能评价系统评定。手术方法:所有患者均行三角肌切除术,用带血管神经蒂的背阔肌肌瓣转位代替被切除的三角肌。术后肩外展90°、前屈30°位固定,6周后去除外固定。进行随访观察。结果:全部患者术后平均随访26个月,局部均无复发,转位的肌瓣全部成活,肌力均在Ⅳ～Ⅴ级,肩外展功能在80～90°结论:带血管神经蒂的背阔肌肌瓣转位代替全部切除的三角肌是一种重建肩关节稳定性及外展功能比较理想的手术方法,临床效果满意。

Objective： To study the curative effect of muscle-group resection of the malignant tumor in deltoid muscle and the reconstruction of stability and abduction function of the shoulder-joint, using latissimus-dorsi muscular flap displacement, and to evaluated and analyze the methods, results and clinical value of the surgical intervention. Methods： From January 1999 to August 2004, 8 cases with malignant tumor in deltoid muscle were treated with reconstructive surgery. The cases included 5 males and 3 females, with a mean age of 44.5 （25 to 64 years）. The average time between onset of the symptom and diagnosis of the disease was 14 months （ranging 6 months to 3 years）. The locations of tumor included 6 patients in left and 2 patients in right. The functions of shoulder joints were all evaluated pre-operatively and post-operatively, based on MTST evaluation system. The surgical procedure was resection of total deltoid muscle shoulder joint and reconstructed with transferred latissimus dorsi muscular flap, which with pedicle. Then fixed in 90° abduction and 30° anterior flexion for 6 weeks. All cases were followed up. The clinical results were evaluated pre-operatively and post-operatively. Results： All the cases were followed up for 6 months to 4 years （averaging 26 months） without tumor recurrence, all displaced muscle flap survived, with an average muscles power of grade Ⅳ to Ⅴ and the shoulder-joint abduction of 80 to 90 degree. Conclusion： Displacement of the excised deltoid muscle with vascular and neural pedicle latissimus an ideal operation method, and satisfactory dorsi muscle flap, after resection of total deltoid muscle, is results has been obtained.