肱三头肌长头重建肩外展的解剖与临床应用

ANATOMICAL STUDY AND CLINICAL APPLICATION OF LONG HEAD OF TRICEPS MUSLE FOR RECONSTRUCTION OF SHOULDER ABDUCTION

目的 对肱三头肌长头进行解剖。描述重建肩外展功能的手术方法 ,并进行临床随访 ,明确手术的效果。方法 对 44侧成人上肢标本解剖观察肱三头肌长头起点的性质、血管神经蒂形态、最大游离范围及入肌点部位。对 6例臂丛神经损伤患者行肱三头肌长头起点移位重建肩外展功能 ,术后随访 3～ 11个月 ,观察临床应用效果。结果 肱三头肌长头起点的背侧为肌性 ,腹侧为腱性 ,腱性长度为 7.6～ 13.3cm,宽度为 1.6～ 3.4cm。肱三头肌长头血管神经蒂距肌肉起点的距离 5 .7～ 11.4cm。神经支配来自桡神经 ,可分离长度 2 .9～ 11.8cm。血供来自肱动脉的 19侧 ,来自肱深动脉的 2 0侧 ,其它来源 5侧。肱动脉来源的血管蒂长 1.0～ 6 .0 cm,直径为 1.6～2 .4mm。肱深动脉的血管蒂可分离长度 1.5～ 4.4cm,直径为 0 .9～ 2 .4m m,分离至肱动脉长度为 1.5～ 6 .3cm。神经血管蒂呈多级分支。6例行肱三头肌长头重建肩外展 ,术后平均随访 6 .8个月 ,术前肩外展 5°(0°～ 10°) ,术后肩外展 77.3°(5 0°～ 90°)。结论 肱三头肌长头可适用于肩外展功能重建的手术 ,经术后随访 。

Objective To study the morphological character of long head of triceps muscle for clinical application in reconstruction of shoulder abduction. Methods Forty four upper extremities of fixed human adult cadavers were carefully dissected. The origins and the pedicles of blood vessels and nerves of long head of triceps muscle, as well as the maximum available size of the muscles, were measured. Six cases of clinical application of long head of triceps muscle for reconstruction of shoulder abduction were followed up for 3 to 11 months. Results The origins in the dorsal side of long head of triceps muscle were muscular and the ventral side were tendonous, which was 7.6 to 13.3 cm in length and 1.6 to 3.4 cm in width. The distance from the origin to the neurovascular pedicle was 5.7 to 11.4 cm. The radial nerve, which innervated the muscles, could be dissected for 2.9 to 11.8 cm in length. The blood supplies to the triceps muscle were from humeral artery (43.2%), 1.0 to 6.0 cm in length and 1.6 to 2.4 mm in diameter, and from humeral profundus artery (45.5%), 1.5 to 4.4 cm in length and 0.9 to 2.4 mm in diameter, if the vessel was separated to the humeral artery, the length was 1.5 to 6.3 cm. The neurovascular pedicles were multiple branched. In the 6 cases of clinical application of the triceps muscles, the operated shoulder could abduct from 5° preoperatively (0° to 10°) to 77.3° (50° to 90°) postoperatively. Conclusion In accordance to the anatomical character of the triceps muscles, the long head of triceps muscle is a suitable choice for reconstruction of shoulder abduction with optimistic outcomes.