游离前臂皮瓣移植术后对手功能影响的研究  

A study of the effect of free forearm flap transfer on hand function

作　　者：颜廷元[1] 柯学平[1] 袁春平[1] 杨建荣[1] YAN Tingyuan;KE Xueping;YUAN Chunping;Yang Jianrong(Institute of Stomatology,Nanjing Medical University,Department of Oral&Maxillofacial Surgery,Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学口腔医学研究所南京医科大学附属口腔医院口腔颌面外科

出　　处：《口腔医学》2019年第12期1095-1098,共4页Stomatology

基　　金：江苏省自然科学基金(BK20151561)

摘　　要：目的探讨口腔颌面部软组织缺损应用前臂游离皮瓣修复后对手功能的影响。方法选择36例行游离前臂皮瓣移植的患者,评估患者左手臂的手功能,包括皮温、肘关节与腕关节屈伸度、握力值、末梢指甲微循环测试、冷、热觉、痛觉及外形美观评价。选择患者的右侧手臂作为对照,进行相同测试。进行同一患者左右侧对比分析,统计学方法采用配对t检验和秩和检验。结果患者左右手的握力不存在显著差异;前臂皮瓣供瓣区的感觉功能较对侧有显著差异;5例左手虎口区有麻木感的患者左虎口区的感觉功能较对侧有显著差异,其余31例患者左手虎口区的感觉功能较对侧无显著差异;左手皮温,末梢指甲微循环及肘关节、腕关节屈伸度的检查结果与对侧相比无显著差异。结论游离前臂皮瓣移植修复虽需牺牲桡动脉这一前臂主要供血动脉,但通过尺动脉的代偿作用及侧枝循环的完善,患者手部的血供仍然可以得到保证。配合术中小心操作,避免神经的损伤,那么将对前臂中远期运动功能及感觉功能无明显影响。Objective To investigate the effects of free forearm flap on hand function in patients who had oral and maxillofacial soft tissue defects. Methods Experimental subjects included 36 patients who underwent forearm free flap transfer. The hand functions of patients were assessed by clinical follow-up. The experimental data of skin temperature, degree of flexion and extension of elbow and wrist joint, grip, cold sensation, heat sensation, pain and evaluation of appearance were recorded. The contralateral hands of the same patients as controls underwent the same tests. The results of the left and right sides of the same patient were further compared and paired t-test and rank-sum test were used. Results There was no significant difference in hand grip of patients but there was difference in feeling at skin graft area after flap harvest as compared with the contralateral side. Five patients had a feeling of numbness around the dorsal surface of thumb. Sensory function of the dorsal surface of left thumb in these patients was significantly different as compared with the contralateral side, while the remaining 31 patients had no significant difference. There were no significant differences in skin temperature, peripheral nail microcirculation, elbow and wrist flexion and extension degree of left hand compared with the contralateral side. Conclusion Free forearm flap transfer needs sacrificing radial artery, but the blood supply of hand can still be guaranteed by the compensatory effect of ulnar artery and the improvement of collateral circulation. It has no significant adverse effects on patient’s hand function when careful dissection is performed to avoid nerve injury during flap harvest.

关 键 词：游离前臂皮瓣 桡动脉 手功能 

分 类 号：R782.24[医药卫生—口腔医学] R622[医药卫生—临床医学]