功能性股外侧肌浅区移植急诊重建创伤性动力肌肉缺损初步临床研究  

Functional muscular transfer of lateral femoral muscle superficial region in emergency reconstruction of traumatic defects of dynamical muscle: A report of preliminary clinical study

作　　者：郑晓菊 李海军 王新宏 王保山 张金明 张忠 代创国 宋文斌 ZHENG Xiaoju;LI Haijun;WANG Xinhong;WANG Baoshan;ZHANG Jinming;ZHANG Zhong;DAI Chuangguo;SONG Wenbin(Department of Hand and Foot Microsurgery Hospital,Xi'an Fengcheng Hospital,Xi'an 710016,China)

机构地区：[1]西安凤城医院手足显微外科病院,西安710016

出　　处：《中华显微外科杂志》2023年第1期25-31,共7页Chinese Journal of Microsurgery

基　　金：陕西省自然科学基础研究计划项目(2023-JC-YB-724)。

摘　　要：目的探讨急诊股外侧肌浅区肌肉移植进行创伤性主要肌肉缺损功能重建的可行性及临床效果。方法自2020年3月至2021年12月,西安凤城医院手足显微外科病院急诊收治股外侧肌浅区重建动力肌肉缺损8例,其中男7例、女1例。年龄23~52岁,平均37.6岁。机器挤压伤5例,重物压砸伤2例,车祸伤1例。前臂GustiloⅢB型损伤5例,其中屈指肌群缺损2例,伸指肌群缺损2例,掌背侧屈指肌和伸指肌同时缺损1例,左侧2例、右侧3例;右第1掌骨缺损伴皮肤及鱼际肌缺损1例;右臂完全离断及肌皮神经自肱二头肌抽出1例;右小腿GustiloⅢC型损伤伴长伸肌和趾伸肌缺损1例。软组织缺损面积10.0cm×8.0cm~36.0cm×11.0cm,切取皮瓣面积12.0cm×6.0cm~38.0cm×12.0cm,切取肌肉体积为18.0cm×9.0cm×1.5cm~10.0cm×2.0cm×1.0cm,采用肌骨B超测量健侧相应缺损的主要肌肉解剖横截面积、长度;在股前外侧设计嵌合移植组织瓣,按创面大小设计皮瓣,根据肌肉缺损情况在股外侧肌浅区设计并切取相应的皮瓣和1个或2个肌肉组织块,覆盖创面的同时行肌肉动力重建。随访方法为出院后定期来院复查,内容是通过肌骨B超、肌电图和肌力等动态观察、随访评估并记录。结果本组所有病例移植肌肉及皮瓣均Ⅰ期成活,无血管危象发生,术后随访10~32个月,平均19.6个月。按肌力M4强度定义方法进行肌力评定,肌力恢复M4及以上的7例,可以提、钩或推移5~30 kg的物体,关节活动自如;1例肌力恢复M3+。肌骨B超于术后2~4个月可见移植肌肉收缩,其中5例收缩与静息状态横截面积比值为1.45±0.42。肢体外形双侧对称,供区及膝关节均无不适感。皮瓣质地柔软有光泽,均恢复保护性感觉。结论急诊股外侧肌浅区肌肉移植进行创伤性肌肉缺损的功能重建是可行的,并有较好的临床效果。Objective To explore the feasibility and clinical effect of emergency lateral thigh muscle transfer in functional reconstruction of major traumatic muscle defects.Methods Emergency surgeries for 8 patients(7 males and 1 female)with muscle defects were carried out subject to emergently reconstruct the power of lateral femoral muscle superficial region,between March 2020 and December 2021,in the Department of Hand and Foot Microsurgery Hospital,Xi'an Fengcheng Hospital.The 8 patients were 23 to 52 years old with an average of 37.6 years old.Five patients injured by machine crush,2 by heavy object crush and 1 by traffic accident.Five patients were in Gustilo III B injury in forearm,including 2 with flexor muscle group defects,2 with extensor muscle group defects and 1 with defect of dorsal metacarpal flexor muscle and extensor muscle.Among the 5 patients,2 patients had the defects in left forearm and 3 in right forearm.One patient had defect of right 1st metacarpal bone and skin and thenar muscle.One patient suffered a complete right upper arm detachment with musculocutaneous nerve being drawn out from the bicipital muscle.One patient had Gustilo III C injury in the right calf with defects of extensor hallucis longus and extensor digitorum.The areas of soft tissue defect were 10.0 cm×8.0 cm-36.0 cm×11.0 cm and the size of flaps was 12.0 cm×6.0 cm-38.0 cm×12.0 cm with the volumes of excised muscle at 18.0 cm×9.0 cm×1.5 cm-10.0 cm×2.0 cm×1.0 cm.The anatomical cross-section and length of the corresponding muscle on the healthy side were measured by musculoskeletal ultrasound.The chimeric tissue flap was designed on the anterolateral side of the thigh.The flap was designed according to the size of the wound and the corresponding flap.Then 1 or 2 muscle tissue blocks were designed and cut from the superficial region of the lateral femoral muscle according to the condition of the muscle defect,to cover the wound and reconstruct the muscle power.Postoperative follow-ups were conducted by scheduled hospital visit.Th

关 键 词：股外侧肌浅区 肌肉移植 肌肉动力 外伤性肌肉缺损 功能重建 

分 类 号：R622.2[医药卫生—整形外科]