摘要
目的探讨前臂桡侧皮瓣移植术后供区功能障碍的原因及预防措施。方法对４８例头颈部缺损行前臂桡侧皮瓣重建病人的供区手臂功能进行术前与术后的对比研究，感觉功能评价参照ＢＭＲＣ标准并计百分比，运动功能评价采用配对ｔ检验。结果术后早期，９３．７５％病人的桡神经分布区以及５０．００％病人的正中神经分部区感觉功能在Ｓ４以下；至术后１ａ时，９２．８６％病人的桡神经分布区的感觉功能恢复至Ｓ３以上，正中神经分布区的感觉功能均恢复至Ｓ４水平。术后６月时，桡偏、尺偏、掌屈、背伸、握力均较术前显著降低（Ｐ均＜０．０１），随访１ａ时，除尺偏、背伸仍较术前显著降低（Ｐ均＜０．０５）外，余均恢复正常。结论供区手臂的运动功能障碍是暂时的，可通过功能训练完全恢复；桡神经分布区的感觉功能障碍较为普遍，其主要原因为桡神经浅支损伤，多能较好恢复；桡神经浅支切断的发生率较低，但其感觉功能恢复较差；术中保护桡神经浅支及改进操作可防止或减少供区功能障碍。
Objective To probe into the causes of morbidity in radial forearm flap (RFF) donor site and
propose corresponding preventive measures . Methods Comparison between the pre- and
post-operative functions in the donor site was performed in 48 patients who had their head-neck
defects reconstructed. The sensory function was assessed by referring to BMRC standards,
and the motor function by paired test. Results In early postoperative period, the sensory
function in 93.75% of the radial nerve-innervated area and 50% the median nerve-innervated
were subnormal (below S4). One year later, the sensation surpassed S3 in 92.86% of the radial
nerve-innervated sites and reached normal (S4) in all of the median nerve innervated sites. The
motor function, including radial deviation, ulnar deviation, palmar flexion, dosi-extension and
grip strength, were all significantly depressed, compared with the preoperative values (P<0.01).
By the end of one-year follow-up, the motor functions recovered, except ulnar deviation and
dorsi-extension remaining subnormal (P<0.05). Conclusion The motor morbidity is reversible
and can recover through exercise. The sensory disturbances due to damage of the superficial
branch of radial nerve occur frequently and the recovery is satisfactory in most cases.
However, a complete cut of the superficial branch, though rarely occurs, usually results in
permanent loss of sensation. Care should be taken to preserve the superficial branch of radial
nerve and improve operative skills so as to avoid or minimize the morbidities.
出处
《徐州医学院学报》
CAS
1999年第3期183-186,共4页
Acta Academiae Medicinae Xuzhou
