吻合与不吻合股前外侧皮神经的股前外侧皮瓣修复四肢软组织缺损的疗效比较

Repair of extremity soft tissue defects using anterolateral femoral flaps with versus without anastomosis of anterolateral femoral cutaneous nerve

目的比较吻合与不吻合股前外侧皮神经的股前外侧皮瓣修复四肢软组织缺损的疗效,探讨吻合皮神经的必要性。方法回顾性分析2019年9月至2022年3月期间上海交通大学医学院附属第六人民医院骨科收治的30例四肢软组织缺损患者资料。根据术中是否吻合股前外侧皮神经分为两组:吻合组14例,男7例,女7例;年龄为(46.4±15.2)岁;软组织缺损范围为(22.4±7.3)cm×(8.5±1.3)cm;采用吻合股前外侧皮神经的股前外侧皮瓣进行修复。非吻合组16例,男11例,女5例;年龄为(39.9±15.8)岁;软组织缺损范围为(23.0±6.4)cm×(9.0±2.1)cm;采用股前外侧皮瓣进行修复,不吻合神经。比较两组患者的皮瓣成活情况、Semmes-Weinstein单丝触觉恢复程度及恢复面积、冷热感及两点辨别觉恢复时间等。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。30例患者的皮瓣均完全存活,未发生血管危象。吻合组患者Semmes-Weinstein单丝触觉面积恢复到20.0%、50.0%、80.0%时所需时间[(2.5±0.7)、(6.7±1.1)、(11.0±1.2)个月]均显著短于非吻合组患者[(3.6±1.3)、(8.6±1.4)、(15.0±2.2)个月],末次随访时恢复面积[100.0%(100.0%,100.0%)]显著大于非吻合组患者[84.6%(81.7%,89.9%)],冷热感恢复时间[(3.9±0.7)个月]显著短于非吻合组患者[(6.1±1.1)个月],差异均有统计学意义(P<0.05)。吻合组14例患者两点辨别觉恢复时间为(10.4±1.7)个月,非吻合组16例患者中仅7例患者恢复两点辨别觉,恢复时间为(14.7±1.4)个月,两组比较差异有统计学意义(P<0.05)。结论对于四肢软组织缺损患者,与不吻合皮神经比较,吻合股前外侧皮神经的股前外侧皮瓣可以在一定程度上保证皮瓣的感觉恢复。

Objective To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics,The Sixth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022.The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps.In the anastomosis groups of 14 cases,there were 7 males and 7 females,with an age of(46.4±15.2)years and a flap size of(22.4±7.3)cm×(8.5±1.3)cm.In the non-anastomosis group of 16 cases,there were 11 males and 5 females,with an age of(39.9±15.8)years and a flap size of(23.0±6.4)cm×(9.0±2.1)cm.The 2 groups were compared in terms of flap survival,Semmes-Weinstein recovery degree and area of monofilament tactile sensation,and time periods for temperature sensation and two-point discrimination.Results There was no statistically significant difference between the 2 groups in the preoperative general data,showing they were comparable(P>0.05).All the flaps survived completely without vascular crisis.In the anastomosis group,the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%,50.0%,and 80.0%[(2.5±0.7)months,(6.7±1.1)months,and(11.0±1.2)months]were significantly shorter than those in the non-anastomosis group[(3.6±1.3)months,(8.6±1.4)months,and(15.0±2.2)months],the recovery area at the last follow-up[100.0%(100.0%,100.0%)]was significantly larger than that in the non-anastomosis group[84.6%(81.7%,89.9%)],and the time period for recovery of temperature sensation[(3.9±0.7)months]significantly shorter than that in the non-anastomosis group[(6.1±1.1)months](all P<0.05).The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was(10.4±1.7)months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after(14.7±1.4)months,showing a significant difference between the 2 groups(P<0.05).Conclusion In the repair of extremity soft tissue defects using anterolateral femoral flaps,compared with no anastomosis of the cutaneous nerve,anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.