带胸大肌肌蒂锁骨段截骨入路在锁骨后方臂丛肿瘤切除中的应用  

Clavicular osteotomy approach with pectoralis major muscle pedicle in the resection of brachial plexus tumour behind clavicle

作　　者：黄泽林 杨俊涛 段梦娴 朱怡 李浩 何盛茂 刘辉成 向仁堃 HUANG Zelin;YANG Juntao;DUAN Mengxian;ZHU Yi;LI Hao;HE Shengmao;LIU Huicheng;XIANG Renkun(Department of Hand and Foot Surgery,The Second Affiliated Hospital of Hengyang Medical School,University of South China,Hengyang,Hunan Province 421000,China;Department of Academic Affairs,Hengyang Campus of Changsha Medical College,Hengyang,Hunan Province 421000,China)

机构地区：[1]南华大学衡阳医学院附属第二医院手足外科,湖南衡阳421000 [2]长沙医学院衡阳校区教研室,湖南衡阳421000

出　　处：《中华显微外科杂志》2022年第2期162-166,共5页Chinese Journal of Microsurgery

基　　金：湖南省卫生健康委科研计划课题项目(C2019103)。

摘　　要：目的探讨带胸大肌肌蒂锁骨段截骨入路在锁骨后方臂丛肿瘤手术切除中的优势及临床应用价值。方法2010年4月至2020年12月,收治锁骨后方臂丛肿瘤患者6例,其中左侧2例,右侧4例,肿瘤位于臂丛上干2例,中干2例,内侧束1例,后束1例。术前神经功能评定为Ⅱ级3例,Ⅲ级3例。肿瘤大小为3.0 cm×3.0 cm×2.0 cm~11.0 cm×8.0 cm×6.0 cm。采用带胸大肌肌蒂锁骨段截骨入路暴露视野,切除神经肿瘤,所有患者术后通过定期门诊复诊和微信电话等方式进行随访,记录患肢感觉、肌力恢复、肿瘤复发及骨折愈合情况。结果术中发现2例肿瘤在完整剥离后,神经鞘膜内仍残留少许神经胶质样变组织。术后病检回报肿瘤性质为神经鞘瘤4例,恶性周围神经鞘瘤1例,神经脂肪瘤1例。术后随访6~34个月,平均12.8个月,所有患者术后无臂丛损伤症状及肿瘤复发,患者临床症状均较术前缓解或消失,按神经功能评定标准达Ⅲ级5例,Ⅳ级1例。同时锁骨内固定满意,均实现骨性愈合,愈合时间为2.5~4.5个月,平均3.2个月,3例在术后1年取出内固定。无明显肢体运动障碍及肩周炎等并发症发生。结论带胸大肌肌蒂经锁骨段截骨入路在治疗锁骨后方臂丛肿瘤的手术中,能充分暴露臂丛的解剖走行及肿瘤与周围组织的毗邻关系,利于肿瘤的完全切除及发现残留瘤样组织,降低手术风险及肿瘤复发率,同时给锁骨截骨段提供丰富血运,促进骨折愈合,是处理锁骨后方臂丛肿瘤的一种可行方法。Objective To explore the advantages and value for clinical application of clavicle segment osteotomy approach with pectoralis major muscle pedicle in surgical resection of posterior brachial plexus tumour.Methods From April 2010 to December 2020,6 patients with brachial plexus tumour behind the clavicle were treated.Two patients had the tumour on the left brachial plexus and 4 on the right.Two patients had the tumours located in the upper trunk of brachial plexus,2 in the middle trunk,1 in the medial plexus and 1 in the posterior bundle.The neurological function evaluation were grade Ⅱ in 3 cases and grade Ⅲ in 1 case preoperatively.The tumours sized from 3.0 cm×3.0 cm×2.0 cm to 11.0 cm×8.0 cm×6.0 cm.The clavicular segment osteotomy approach with the pedicle of the pectoralis major was applied in order to expose the surgical field and remove the nerve tumour.All patients underwent regular postoperative outpatient clinic follow-up to record the sensation of the affected limb and the recovery of muscle strength,tumour recurrence and fracture healing.Results In the operation,it was found that there was still a little glial-like tissue in the nerve sheath after complete dissection of the tumours in 2 patients.Postoperative pathological examination reported that there were 4 schwannoma,1 malignant peripheral schwannoma and 1 neurolipoma.The postoperative follow-up lasted for 6 to 34 months,with an average of 12.8 months.All patients showed no symptoms of brachial plexus injury or tumour recurrence.The clinical symptoms were relieved or disappeared.The neurological function evaluation reached grade Ⅲ in 5 patients and grade Ⅳ in 1 case.At the same time,the internal fixation of the clavicle was satisfactory and achieved bone union in all cases.Fracture healing time was 2.5 to 4.5 months,with an average of 3.2 months.The internal fixation was removed from 3 patients after operation in 1 year.No obvious limb movement disorder and periarthritis of shoulder and other complications occurred.Conclusion The transcl

关 键 词：臂丛肿瘤 锁骨截骨 胸大肌肌蒂 显微外科技术 

分 类 号：R738[医药卫生—肿瘤]