游离股薄肌移植在创伤后肢体功能重建中的应用

Application of free gracilis transplantation in reconstruction of traumatic limb

由高能量损伤导致的肢体重要神经损伤或主要肌群毁损后的功能重建一直是困扰创伤骨科医生的难题。当局部没有可供选择的肌肉、肌腱及动力神经移位重建时,具有疗效确切、恢复迅速等优点的游离功能肌肉移植已成为肢体严重损伤后功能重建的理想方法。股薄肌由于具有肌腱长、延展性好、血供恒定、血管神经蒂长、供区部位隐蔽、无明显供区功能丧失、吻合一套主要血管蒂可以供养整块肌肉及肌肉表面的皮瓣等解剖特点,被认为是游离功能肌肉移植的理想供区,临床应用广泛。单一股薄肌、双重股薄肌、吻合单一血管蒂的长收肌-股薄肌移植等各具特色而能满足不同的临床需要。同时,作为决定游离功能肌肉移植术后运动功能恢复关键的受区最佳动力神经,也一直受到诸多学者的关注。本文主要介绍游离股薄肌移植重建肢体动力功能的发展、股薄肌的应用解剖及其在肢体重要神经损伤及肢体毁损伤后主要肌群缺损功能重建中的应用,为临床应用提供参考。

Functional reconstruction of a major injured nerve or muscle group in a destructive limb caused by high energy has always been a big problem for trauma orthopedists. When no local tendon, muscle or nerve is available for transference, functional free muscle transplantation (FFMT) is an ideal functional recon-struction method for severe limb injury characterized by definite curative effect and quick recovery. Gracilis is considered to be an ideal donor site for FFMT because of its anatomic features of long tendon, good excursion, stable blood supply, long neurovascular pedicle, shaded donor site, little donor site loss and sufficient nour-ishment of the whole musculocutaneous flap by anastomosis of one single major pedicle. It has been widely ap-plied in clinics. Transplantation of single free gracilis flap, double free gracilis flaps, and adductor longus-gracilis flap with single pedicle anastomosis can meet different clinical applications. The best donor motor nerve, which is critical to functional restoration of the affected limb using FFMT, is always a major concern to many scholars. This paper focuses on the advances in functioning free gracilis transplantation in reconstruction of limb motor function, applied anatomy of the gracilis and application of functional reconstruction for major nerve injury and major muscle group defects in a destructive limb, hoping to provide useful information for wider clinical application of FFMT.