髂骨复合瓣移植肢体感觉障碍的临床研究

Clinical study on sensory function of limbs following iliac crest composite free flaps transfer

目的 对 38例 40侧髂骨复合瓣移植肢体感觉障碍进行前瞻性临床对照研究。方法 根据术前与术后连续随访中触觉、痛觉及两点辨别觉检查 ,按BMRC感觉评定标准判定肢体感觉障碍恢复情况。结果 ①髂骨复合瓣移植早期感觉障碍较普遍 ,股外侧皮神经损伤率高 ,髂腹下、髂腹股沟神经、股神经发生率低 ,6个月～ 1年左右多能逐渐恢复但不完全。②股外侧皮神经主干误断伤所致感觉丧失多难以恢复。③供区神经痛可能与神经嵌压有关。结论 髂骨复合瓣移植感觉障碍恢复不完全 ,术中应注意保护周围神经 ,尤其股外侧皮神经。

Objective To report the prospective results on sensory function of limbs following iliac crest composite free flaps(ICCFF) transfer.Methods According to the results of touch,prick,two-point discrimination, the standard of the BMRC grading was used to evaluate sensory function.Results Early postoperative sensory changes occurred frequently.Incidence rate of the lateral femoral cutaneous nerve(LFCN) paralysis was higher,paralysis of the ilioinguinal nerve and/or the iliohypogastric nerve and femoral nerve were infrequently encountered.Most of them could recover during 6 months to 1 year,the two-point discrimination was difficult to recover completely.Sensory loss resulting from cutting injury LFCN could not recover. Long-term nuralgia of donor sites possibly ralated to nerves entrapment.Conclusion Sensory changes following ICCFF transfers are difficult to recover completely,emphasis must be placed on protection of peripheral nerves.