背阔肌双极移位重建产瘫儿童屈肘肌功能

Bipolar Transfer of the Pedicled Latissimus Dorsi Muscle Flap for Reconstruction of Elbow Flexion after Brachial Plexus Birth Palsy

目的 :介绍和评价背阔肌双极移位重建臂丛神经产伤后屈肘肌功能障碍的手术方法和结果。方法 :从 1992年 6月～ 2 0 0 2年 6月 ,本科共收治分娩性臂丛神经损伤病人 3 6例 ,其中采取背阔肌双极移位治疗臂丛神经产伤后屈肘肌功能障碍 10例 ,男 4例 ,女 6例 ,手术时平均年龄为 7( 5～ 12 )岁 ,2例患儿在术后 1年因肩关节连枷而行肩关节固定术。结果 :本组 10例病人术后平均随访 3 ( 1.5～ 6)年 ,肘关节屈曲肌力达到 4级以上 ,手触嘴的功能均恢复 ,无神经血管束损伤等手术并发症。结论 :臂丛神经产伤引起的屈肘肌功能障碍严重影响患儿的生活和学习能力 ,需要手术治疗。本组选择的背阔肌双极移位 ,具有操作相对简便、符合生物力学、并发症少和结果确实的优点 ,因此是一种值得推荐的手术方法。

Objective: To introduce and evaluate the results of bipolar transfer of the pedicled latissimus dorsi muscle flap for reconstruction of elbow flexion after brachial plexus birth palsy. Methods: Ten children with dysfunction of elbow flexion after brachial plexus birth palsy were treated with bipolar transfer of the pedicled latissimus dorsi muscle flap for reconstruction of elbow flexion between June 1992 and June 2002. There were four boys and six girls and the age of the patients at operation varied from 5 to 12 years. One year later, 2 patients undergone shoulder joint fusion after reconstruction of elbow flexion due to flaccid shoulder. Results: The average period of follow up were 3 years, ranging from one year and six months to six years. The strength of the latissimus dorsi muscle to be transferred was good or high in rating. Hand to mouth function was recovered in all patients. There were no any complications, such as neurovascular pedicle injury and infection. Conclusion: Dysfunction of elbow flexion after brachial plexus birth palsy reduced the ability of living and studying in patients and must be interfered with operation if possible. Ten patients have been successfully treated with bipolar transfer of the pedicled latissimus dorsi muscle flap for reconstruction of elbow flexion with less invasive and more biomechanical and no complications, therefor it is worthwhile to be recommended for reconstruction of elbow flexion after brachial plexus birth palsy.