股外侧肌浅区部分肌肉移植动力重建可行性的初步研究  

Reconstruction of muscular dynamics with partial superficial vastus of lateral thigh:a preliminary study

作　　者：郑晓菊 李海军 王新宏 蔡鑫 张金明 张忠 代创国 宋文斌 王保山 ZHENG Xiaoju;LI Haijun;WANG Xinhong;CAI Xin;ZHANG Jinming;ZHANG Zhong;DAI Chuangguo;SONG Wenbin;WANG Baoshan(Department of Hand and Foot Microsurgery,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,西安710016

出　　处：《中华显微外科杂志》2023年第6期655-660,共6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：目的探讨股外侧肌浅区部分肌肉移植行创伤性肌肉缺损功能重建的可行性。方法2020年3月-2023年3月,西安凤城医院手足显微外科应用股外侧肌浅区移植行肌肉动力重建9例,其中前臂GustiloⅢB型损伤5例(屈指肌群缺损2例,伸指肌群缺损3例;左侧2例,右侧3例);掌背侧屈指肌和伸指肌同时缺损1例;右第1掌骨缺损伴皮肤及鱼际肌缺损1例;右臂完全离断肌皮神经自肱二头肌抽出1例;右小腿GustiloⅢC型损伤伴胫骨前肌、长伸肌和趾伸肌缺损1例。均通过急诊切取股外侧肌浅区部分肌肉行外伤性肌肉缺损动力重建,术中股外侧肌浅区嵌合移植时在神经入肌前3.0cm部位,切取近端长3.0cm多余神经组织行苏木精-伊红(HE)染色定量神经纤维数检测,术后通过肌骨B超、肌电图和肌力等动态观察、随访评估。期间另外选取在本院行股外侧肌浅区嵌合移植修复的48例进行肌纤维平均长度和厚度的测量,与股薄肌肌纤维长度、神经纤维数进行对比。同时组织本院职工志愿者71例,用肌骨B超进行股外侧肌浅区收缩状态(C)和静息状态(R)的横截面积并记录,计算其比值(CR值)。9例患者术后均采用门诊复诊、电话和网络方式进行随访,观察动力重建肌肉的肌力恢复情况。结果本组9例术中HE染色测得神经纤维数为(1088±213)条,术后肌骨B超测量移植肌肉的CR值为1.44±0.17;术后创面顺利愈合,未出现并发症;随访时间22.6(10~38)个月,关节外形正常,肌力恢复M56例,M43例。48例测得肌肉厚度为(1.74±0.35)cm,肌纤维长度为(8.86±1.59)cm。71例志愿者测得股外侧肌浅区CR值1.17±0.12。结论本研究设计的股外侧肌浅区部分肌肉移植动力重建,初步观察可恢复较好的肢体功能。Objective To explore the feasibility of functional reconstruction of muscle power in treatment of traumatic muscle defects by transferring part of superficial vastus of lateral thigh.Methods From March 2020 to March 2023,reconstruction of muscle power with transfer of superficial lateral thigh muscle was performed on 9 patients in the Department of Hand and Foot Microsurgery of Xi'an Fengcheng Hospital.Nine patients were assigned in a study group.A total of 48 patients who previously had the surgery of chimerically grafted superficial vastus of lateral thigh were recruited as the"previous surgery group"and another group of 71 staff volunteers from our hospital were recruited as the"healthy control group".Of the study group,5 patients had Gustilo typeⅢB injury in forearm(two with defects of flexor muscle group and 3 with extensor muscle group,2 with the defects in the left and 3 in the right),one had defect of both flexor and extensor muscle groups in dorsal hand,one had defect of right 1st metacarpal with defects of soft tissue and thenar muscle,one had a completely severed right upper arm with a withdrawn musculocutaneous nerve from the biceps brachii and one had GustiloⅢC injury in right calf with defects of tibialis anterior,extensor longus and extensor phalangeal muscle.In the emergency surgery,part of the superficial muscles of lateral thigh were taken to reconstruct the muscular power for the defected traumatic muscles.During the surgery,the excessed nerve with a length of 3.0 cm proximally was removed at 3.0 cm from the point where the nerve entered the muscle.In the transfer of superficial chimeric muscle of lateral thigh,a 3.0 cm of sample nerve tissue was taken for HE staining to find out the number of nerve fibers.Musculoskeletal ultrasonography,electromyography and muscle strength test were performed in the postoperative follow-up for observations and evaluations of the effects of surgery.Average length and thickness of muscle were taken from the 48 patients in the"previous surgery group".The meas

关 键 词：股外侧肌浅区 肌肉动力 外伤性肌肉缺损 关节活动 神经纤维 上肢 

分 类 号：R658[医药卫生—外科学]