游离腓肠肌肌皮瓣重建外伤性前臂屈肌缺损  

Reconstruction of forearm flexors by gastrocnemius myocutaneous flap transfer

作　　者：范存义[1] 姜佩珠[1] 蔡培华[1] 孙鲁源[1] 傅麟[1] 曾炳芳[1] 

机构地区：[1]交通大学附属第六人民医院骨科,上海200233

出　　处：《中华手外科杂志》2006年第3期162-164,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨应用游离腓肠肌内侧头肌皮瓣重建前臂屈肌功能的可行性与有效性。方法对3例前臂屈肌缺损的患者,采用游离腓肠肌内侧头肌皮瓣重建屈指功能。将正中神经肌支与支配腓肠肌内侧头的胫神经分支缝合,桡动脉(或尺动脉)、前臂浅静脉分别与胫后动、静脉发出的腓肠肌内侧头动、静脉分支相吻合。腓肠肌内侧头起点固定在肱骨内上髁上,调整肌张力后将止点的跟腱部分与1～5 指指深屈肌腱编结缝合。屈腕位石膏固定3周后,开始功能锻炼。结果术后肌皮瓣全部存活。术后平均随访7．5周时,电生理检测肌皮瓣出现动作电位,手指稍有屈曲动作;平均随访至28个月时,3例指屈肌肌力均达4级。供区植皮创面愈合良好,距小腿关节(踝关节)跖屈肌力接近正常,无外翻畸形,行走时步态正常。结论应用游离腓肠肌内侧头肌皮瓣重建前臂屈肌缺损,术后肌肉功能恢复快,疗效肯定。Objective To study the feasibility and effectiveness of gastroenemius myoeutaneous flap transfer for reconstruction of forearm flexors. Methods 3 cases of post-traumatic loss of forearm flexors were treated by transferring gastrocnemins myocutaneous flap to reconstruct flexion function. Muscle branches of the median nerve were dissected and coapted to the muscle branch of the tibial nerve to the medial head of the gastroonemius muscle. Ulnar or radial artery and cephalic vein were used as the recipient vessels and were anastomosed with the medial branch of the popliteal vessels to the medial gastrecnemius, The starting point of the medial gastrecnsmius was anchored to the medial condyle of the distal humerus. 1/3 of the medial Achilles tendon was preserved as the insertion, and sutured to the flexor digitorum profundus, Tension of the transferred gastrecnemius muscle was adjusted as so the wrist joint was at 25° of flexion, metacarpophalangeal joints 30° of flexion, proximal interphalangeal joints 25° of flexion, and distal interphalangeal joints 15° of flexion. All those joints were immobilized for 3 weeks before rehabilitation began. Results All flaps survived. Muscle action potential occurred 7.5 weeks following the operation. Slight finger flexion was also noted at this time. Evaluation at 21 months follow up revealed muscle strength of the transferred muscle reached MRC3 in 1 ease and MRC4 in 2 eases with satisfactory contour. Skin graft of the donor area healed aneventfully. Plantar flexion of the foot was near normal, None of the patients had valgus deformity of the ankle joints. The gait was normal. Conclusion Due to the resemblance to the forearm flexors, the medial head of the gastrocnemius can be transferred for reconstruction. The recovery time is relatively short and the results reliable.

关 键 词：组织缺损 屈指功能 重建 腓肠肌皮瓣 

分 类 号：R658.2[医药卫生—外科学]