背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效评价

Curative effect evaluation of latissimus dorsi myocutaneous flap translocation for reconstruction of elbow flexion function in late stage upper brachial plexus injuries

目的 评价背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效。方法 自2008-01—2013-12采用背阔肌肌皮瓣单极移位法重建9例晚期臂丛神经上干损伤屈肘功能,其中5例将背阔肌远端分别固定于肱桡肌及肱二头肌腱和4例采用传统方法。结果 背阔肌肌皮瓣全部存活,伤口愈合良好,无感染等并发症发生。9例获得随访12~36个月,平均28个月。7例术后肌力恢复到M4,2例肌力恢复到M3,屈肘角度50°~110°,平均91°。患者术前、术后肌力比较,差异有统计学意义（t=9.34,P〈0.05）。根据远端固定2种方式,采用多元T统计分析2组肌力、屈肘力量、角度恢复程度,两者差异无统计学意义（F=1.18,P〉0.05）。结论 采用背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效满意。

Objective To evaluate the curative effect of the latissimus dorsi myocutaneous flap translocation for reconstruction of elbow flexion function in late upper brachial plexus injunes. Methods From January 2008 to December 2013, the latissimus dorsi myocutaneous flap translocation was used to reconstruct elbow flexion function in nine patients with late stage upper brachial plexus injuries. The latissimus dorsi distal fixation in brachioradialis and tendon of Biceps braehii was performed in five patients while the traditional method was used in four patients. Results All the latissimus dorsi myocutaneous flap survived and the wound healed well. No complications such as infection occurred. Nine cases were all followed up for 12 to 36 months, average 28 months. Myodynamia recovered to M4 in seven patients, M3 in two patients. The elbow flexion angle was 50°-110°, mean 91°. In preoperative and postoperative myodynamia, the difference was statistically significant （t =9.34, P 〈0.05）. According to the multivariate T statistical analysis, in myodynamia, elbow flexion strength, recovery degree of elbow flexion angle, there were no statistically significant differences between two fixation method groups （F =1.18, P 〉0.05）. Conclusion The latissimus dorsi myocutaneous flap translocation for reconstruction of elbow flexion function in late stage brachial plexus injuries is satisfactory.