三角肌区软组织肉瘤广泛切除后重建肩外展功能的临床研究

Reconstruction of soft tissue sarcoma in the deltoid muscle region

目的:探讨带血管神经蒂的背阔肌肌皮瓣在三角肌区软组织肉瘤广泛切除后重建肩关节外展功能的临床效果。方法:回顾总结2005年应用带血管神经蒂背阔肌肌皮瓣修复三角肌区软组织肉瘤广泛切除术后组织缺损患者12例,全部病例均行广泛切除手术治疗,切除缘为肿瘤外3cm,软组织缺损面积为(7-10)cm×(14-22)cm,行对血管神经蒂背阔肌肌皮瓣移植重建三角肌。皮瓣切取面积为(7-12)cm×(18-32)cm。手术重建以肩胛下动脉和胸背神经为蒂,将背阔肌倒转移位至肩外侧,按三角肌正常起止点缝合固定。结果:随访时间平均33个月,1例因远处转移死亡,其余均存活,均无复发。移位肌皮瓣全部成活,肌力Ⅳ级8例,Ⅲ级4例;肩主动外展90°7例,80°3例,70°2例。结论:带血管神经蒂的背阔肌肌皮瓣不但可以修复三角肌区肿瘤切除术后的组织缺损,还可以重建肩外展功能,疗效良好。

Objective：To study the rebuilt of shoulder outreach function by neurovascular reserved latissimus dorsi myocutaneous flap in deltoid muscle area soft tissue sarcomas after extensive surgery resection.Methods：Ten cases of soft tissue sarcomas in deltoid muscle area were retrospectively studied.Neurovascular reserved latissimus dorsi myocutaneous flap was utilized to repair tissue defects after extensive resection;the surgical margins were over 3 cm,soft tissue defect area was（7-10） cm ×（14-22） cm.Deltoid muscle was rebuilt by neurovascular reserved latissimus dorsi myocutaneous flaps of（7-12） cm ×（18-32） cm in size.The subscapular artery and thoracodorsal nerve were reverse as a pedicle,latissimus dorsi myocutaneous flaps were rotated and shift to the shoulder region,and sutured according to anatomy starting and ending point of deltoid muscle.Results：The average follow-up time was 33 months.One case died of distal metastasis,and the rest cases were alive with no evidence of recurrence.The translocated myocutaneous flaps were vital,muscle strength grade 4 in 6 cases,grade 3 in 4 cases;shoulder active outreach 90° in 7 cases,80° in 3 cases,70° in 2 cases.Conclusion：The neurovascular＇reserved latissimus dorsi myocutaneous flap is applicable not only in the rebuilt of tissue defects after extensive resection for tumors in deltoid muscle area,but also reconstruct the shoulder outreach function with a good clinical outcome.