功能性游离肌肉移植重建部分上肢功能的临床应用

Clinical application of three kinds of functional free muscle transplantation to reconstruct partial upper limb function

目的探讨应用3种功能性游离肌肉移植重建部分上肢功能手术的疗效,结合相关解剖基础分享临床经验。方法2010年1月至2018年12月,应用功能性游离股薄肌、背阔肌、胸小肌移植重建上肢功能手术治疗患者39例,包括重建屈肘和屈指功能6例,屈指功能11例,拇对掌功能22例。根据肢体情况选择不同的动力神经和供血血管,术中调节移植肌肉于最佳肌张力水平,重建移植肌肉的神经和血运。结果功能性游离肌肉完全成活37例,重建的上肢功能恢复良好,优、良率达94.8%;重建功能未恢复者2例,其中1例出现移植肌肉和皮瓣部分坏死。结论应用功能性游离股薄肌、背阔肌和胸小肌移植重建上肢功能手术效果满意,是治疗各种原因导致的上肢肌肉缺损及严重肢体障碍的有效方法。

Objective To explore the clinical effect and experience of three kinds of functional free muscle transplantation in the reconstruction of partial upper limb function.Methods From January 2010 to December 2018,functional free gracilis,latissimus dorsi and pectoralis minor muscle transplantation were applied to reconstruct upper limb function in 39 cases,including reconstructing elbow flexion and finger flexion function in 6 cases,finger flexion function in 11 cases,and thumb opposable function in 22 cases.Different dynamic nerves and blood supply vessels were selected according to the conditions of the limbs,and the transplanted muscles were adjusted in the optimal position of muscle tension during the operation to rebuild the nerve and blood supply of the transplanted muscles.Results In 37 cases,the functional free muscle survived completely,and the reconstructed upper limb recovered well.Excellent and good rates were 94.8%.In 2 cases,the reconstructed function did not get recovered,and 1 case occurred partially necrotic in the transplanted muscle and flap.Conclusions The functional free gracilis,latissimus dorsi and pectoralis minor muscle transplantation have a satisfactory result in the reconstruction of upper limb function,which is an effective method for the treatment of various causes of upper limb muscle defects and severe limb disorders.