游离股薄肌移植重建臂丛损伤的早期并发症分析  

Analysis of early complications of free gracilis muscle transfer in reconstruction of brachial plexus injury

作　　者：陈剑平 杨建涛[1] 秦本刚[1] 王洪刚[1] 顾立强[1] CHEN Jianping;YANG Jiantao;QIN Ben’gang;WANG Honggang;GU Liqiang(Department of Microsurgery,Trauma and Hand Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510008,China)

机构地区：[1]中山大学附属第一医院显微创伤手外科,广州510080

出　　处：《中华显微外科杂志》2021年第2期166-170,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871787)。

摘　　要：目的:探讨游离股薄肌移植重建臂丛损伤术后早期并发症发生的可能原因及预防措施,为进一步提高股薄肌移植术后的功能提供参考。方法:选取2005年8月-2016年12月行功能性股薄肌移植重建臂丛损伤111例,记录术后早期并发症,包括受区、供区及全身并发症。记录皮瓣危象发生的时间、危象类型及抢救结果,计算皮瓣移植成功率、皮瓣危象发生率和抢救成功率等,并进行统计学分析,P<0.05为差异有统计学意义。根据BMRC评分系统评估股薄肌术后的肌力。结果:本组111例共122块游离股薄肌移植,成功率为98.4%(120/122),发生早期并发症32例,其中6例同时出现2项并发症:受区并发症27例(84.4%),供区并发症4例,全身并发症7例。其中发生皮瓣危象17块,抢救成功15块,抢救成功率88.2%。皮瓣危象是影响股薄肌术后功能的主要因素,58.8%(10/17)的危象组患者术后股薄肌肌力达M 3以上。发生血管危象的主要原因是静脉迂曲和静脉栓塞,与手术时间和术中出血量无关。结论:皮瓣危象是影响股薄肌术后功能的主要因素,术后早期发现并及时手术探查是提高皮瓣危象抢救成功率最有效的方法。Objective To explore the causes and preventive measures of early complications after free gracilis muscle transfer in reconstruction of brachial plexus injury,and to improve the postoperative function of the transferred gracilis muscle.Methods Patients were recruited from August,2005 to December,2016.All 111 patients of brachial plexus injury underwent reconstructive surgery using 122 free gracilis flaps.Early postoperative complications,including recipient site,donor site and systemic complications,were closely observed and recorded.Outcome measurements included incidence and timing of flap compromise,type of flap compromise,causes of vascular occlusion and salvage rate.The postoperative strength of gracilis was evaluated according to the BMRC score.The data were statistically analyzed.The difference was statistically significant if P<0.05.Results The survival rate of 122 free gracilis transfers was 98.4%(120/122).Early complications occurred in 32 cases(including 2 complications in 6 patients):27 cases with recipient site complications(84.4%),4 with donor site complications and 7 with systemic complications.Among the 32 cases of complications,17 flap compromises caused by vascular obstruction and 15 of them were salvaged completely after exploration.Flap crisis was the main issue that affected the postoperative function of gracilis muscle,and 58.8%(10/17)of patients with vascular crisis showed muscle strength above M3 after surgery.The main causes of vascular crisis were venous tortuosity and venous thrombosis,which had nothing to do with operation time and intraoperative blood loss.Conclusion Flap crisis is the main factor affecting the postoperative function of gracilis.The rate of flap salvage can be tremendously increased by early detection,re-exploration and effective management of the flap crisis.

关 键 词：臂丛损伤 股薄肌移植 皮瓣危象 并发症 

分 类 号：R658.2[医药卫生—外科学]