双重股薄肌移植重建全臂丛根性撕脱伤后手握持功能

Functional reconstruction of hand prehension after complete root avulsion of brachial plexus by double gracilis transplantations

目的 探讨双重股薄肌移植重建全臂丛根性撕脱伤后手握持功能的疗效。方法 24例全臂丛根性撕脱伤患者,行吻合血管、神经的双重股薄肌移植,一期重建屈肘、伸指、伸拇,二期重建屈指、屈拇,以重建手握持功能。结果 随访16例二期手术后时间超过24月患者,最长62月,平均36月。16例均恢复屈肘、伸指、伸拇功能,屈肘90°～135°,肌力M_4(Highet法),伸指伸拇M_3～M_4。14例屈拇、屈指恢复,肌力M_3～M_4,可握持200～500g物品;2例屈拇屈指肌力M_1。结论 吻合血管、神经的双重股薄肌移植治疗全臂丛根性撕脱伤,可很好恢复屈肘、伸拇伸指功能,较好恢复屈指屈拇功能,初步重建手握持功能。

Objective To explore the effects of double gracilis transplantations in functional reconstruction of hand prehension after complete root,avulsion of hrachial plexus.Methods Double gracilis transplantations with vascularizaliou and neurotizalion were performed in 24 cases of the complete root avulsion of brachial plexus to reconstruct the function of hand prehension.At the first operation,flexion of (he elbow and extension uf fingers and thumb were reconstructed.Then,flexion of fingers and thumb was reconstructed at the second operation.Results Follow-ups were earned out in 16 cases who had been discharged for more than 24 months after the second operation,with the longest discharge lime being 62 months,and their average discharge lime being 36 months.In all the 16 patients the flexion of elbow and extension of fingers and thumb restored.Their elbow flexion was 90-135 and Mi (Highet' s method),and their finger and thumb extension M3M4.14 of them restored the function of finger and thumb flexion,with Mi ~ Mj rnyodynamia,and they were able to achieve prehension of objects of about 200 ~ 500g.Rut the strength of finger and thumb flexion was Mi in the other two cases.Conclusion Double gracilis transplantations with vaseularization and ncurotization are a recommendable management to treat complete root avulsion of brachial plexus,because it etui restore excellent function of elbow flexion and finger and thumb extension,good function of finger and thumb flexion,and reconstruct basic hand prehension.