游离股薄肌移植重建前臂屈指功能  

Free gracilis muscle transplantation for digital flexion function reconstruction

作　　者：陈山林[1] 童德迪[1] 王树锋[1] 栗鹏程[1] 薛云皓[1] 刘波[1] 荣艳波[1] 王志新[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《骨科临床与研究杂志》2016年第1期39-44,共6页Journal Of Clinical Orthopedics And Research

摘　　要：目的介绍游离股薄肌移植重建前臂屈指功能的适应证、手术方法和治疗结果。方法回顾性分析2010年3月至2015年5月采用游离股薄肌移植重建外伤后屈指功能10例。平均年龄14（3～32）岁。男7例，女3例。右侧4例，左侧6例。Volkmann挛缩6例，开放伤后肌肉缺损4例。均采用带皮肤的游离股薄肌移植，神经均选择骨间掌侧神经与闭孔神经前支吻合，皮瓣动脉与肱动脉端侧吻合，静脉与肱动脉伴行静脉或浅静脉吻合。随访18～48个月。测量患肢握力并与健侧进行对比。结果10例患者平均手术时间6h。全部获得随访，平均随访31个月。9例肌皮瓣完全存活，没有出现血管栓塞和感染等术后并发症。1例患者远端边缘皮肤坏死，采用游离植皮覆盖。10例患者供区都没有明显功能障碍。术后3周拆石膏，开始被动活动练习。肌肉恢复功能后，开始主动活动练习。随访1年后，8例患者屈指肌力可达健侧的1／3，平均握力可达13．2kg，主动屈指充分。1例患者伸侧肌腹同时有损伤，后经全腕关节融合术和掌板紧缩术治疗后屈指功能得以改善。1例患儿因缺乏系统锻炼等原因，术后出现肌腱粘连，经肌腱松解，手指仍不能充分屈曲。结论游离股薄肌移植重建屈指功能可以获得满意的疗效，对于前臂屈肌严重损伤病例，是一种值得推荐的治疗方法。Objectives To introduce the indications, surgical techniques and outcomes of using free gracilis muscle transplantation to reconstruct the digital flexion function in forearm. Methods From March 2010 to May 2015, 10 free gracilis muscle transplantations were performed to reconstruct the digital flexion function. The average age of the patients was 14 years old （3 -32 years）. Seven of them were male and the other 3 were female. The fight side forearm were involved in 4 cases, left side in 6 cases. Six of them were Volkmann＇s ischemic contracture, the other 4 cases were suffered from direct trauma. Free gracilis musculocutaneous flap were used for all 10 cases. The anterior branch of obturator nerve was sutured to the anterior interosseous nerve at the recipient site. The end-to-side anastomosis was applied between the artery of the flap and the hrachial artery. The vena eomitantes were anasto- mosed with the vena comitantes of branchial artery or superficial veins. Results The mean time of operation was about 6 h. All 10 cases were followed-up for 18 -48 months （average 31 months）. The musculocutaneous flap survived completely in 9 eases, a small area flap at the distal margin was necrosis in one case and the problem was resolved by skin graft. No significant complication such as vascular thrombosis or infection occurred postoperatively. There were no morbidities at the donor site except wound sear. The east was discarded and passive mobilization was started three weeks after surgery. The active range of motion exercise started once the muscle function restored. The muscle strength（ 13.2 kg in average） was one third of the opposite side and with almost full range of active flexion in 8 cases one year after operation. A total wrist arthrodesis and volar plate advancement were performed for one case due to the associated extensor muscle belly injury. The hand function was improved after wrist fusion. Severe tendon adhesion occurred in one boy because he did not receive systemic physical therapy after o

关 键 词：组织移植 移植 自体 修复外科手术 前臂损伤 缺血性挛缩 

分 类 号：R658.2[医药卫生—外科学]