背阔肌功能恢复后再移位重建屈肘屈指功能

[目的]探讨利用经神经移位修复胸背神经而恢复的背阔肌作为动力肌再移位重建屈肘、屈指功能的疗效。[方法]2000年3月~2003年6月,共有全臂丛根性撕脱伤患者经多组神经移位术后屈肘功能无恢复而背阔肌恢复良好者5例,屈指功能无恢复,背阔肌功能良好者3例,均采用恢复的背阔肌再移位重建屈肘、屈指功能。[结果]术后随访1 a~3 a 6个月,移位背阔肌皮瓣全部成活,肘关节活动度为伸肘10°~25,°屈肘100°以上,肌力达Ⅲ~Ⅳ级。手指可抓握,各指屈距掌纹2 cm左右,肌力达Ⅲ级。[结论]利用经神经移位恢复的背阔肌作为动力肌再移位重建屈肘、屈指功能疗效可靠,因此在治疗全臂丛根性撕脱伤患者时应常规修复胸背神经以恢复背阔肌功能。     

按摩护理挽救静脉危象背阔肌皮瓣1例

肌皮神经损伤将导致上肢肱二头肌麻痹，屈肘功能障碍。Schottstead[1]1955年首先报道了用背阔肌移位重建屈肘功能。由于该肌肌腹大，血管神经蒂恒定，切口隐蔽，因此是屈肘功能重建中的首选方法[2]。为了减轻背阔肌移位后上臂切口张力，增加肌肉滑动范围，便于术后血运观察，临床上常将背阔肌带皮瓣形成背阔肌皮瓣转位来恢复肘关节屈曲活动[3]。但由于切取、移位该肌皮瓣时必然累及血管神经蒂组织，术中及术后仍有发生动、静脉危象的可能，严重时导致肌皮瓣坏死和手术失败。1996～2001年，我们对7例晚期臂丛神经损伤修复术后肌皮神经功能无…     

带血管神经蒂背阔肌胸大肌移位重建屈肘功能

我院近年来分别为3例不完全臂丛神经损伤患者,采用带血管、神经蒂背阔肌、胸大肌肌瓣移位重建屈肘功能获得成功。 例1 男,20岁。因左肩着地摔伤致左臂丛神经损伤11个月入院。检查发现左侧三角肌、肱二头肌、喙肱肌肌力为0级,提肩胛肌、斜方肌、背阔肌肌力Ⅴ级,肱三头肌力Ⅴ级,手及腕部诸肌力正常。入院后先行左肩关节融合术,术中6个月再行左侧带血管、神经蒂背阔肌肌瓣移位代肱二头肌术。术后切取整块背阔肌,保留近端止点及神经血管蒂,在背阔肌     

背阔肌双极移位重建产瘫儿童屈肘肌功能

目的：介绍和评价背阔肌双极移位重建臂丛神经产伤后屈肘肌功能障碍的手术方法和结果。方法：从1992年6月-2002年6月，本科共收治分娩性臂丛神经损伤病人36例，其中采取背阔肌双极移位治疗臂丛神经产伤后屈肘肌功能障碍10例，男4例，女6例，手术时平均年龄为7(5—12)岁，2例息儿在术后1年因肩关节连枷而行肩关节固定术。结果：本组10例病人术后平均随访3(1．5—6)年，肘关节屈曲肌力达到4级以上，手触嘴的功能均恢复，无神经血管束损伤等手术并发症。结论：臂丛神经产伤引起的屈肘肌功能障碍严重影响患儿的生活和学习能力，需要手术治疗。本组选择的背阔肌双极移位，具有操作相对简便、符合生物力学、并发症少和结果确实的优点，因此是一种值得推荐的手术方法。     

背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效评价

目的评价背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效。方法自2008-01—2013-12采用背阔肌肌皮瓣单极移位法重建9例晚期臂丛神经上干损伤屈肘功能,其中5例将背阔肌远端分别固定于肱桡肌及肱二头肌腱和4例采用传统方法。结果背阔肌肌皮瓣全部存活,伤口愈合良好,无感染等并发症发生。9例获得随访12~36个月,平均28个月。7例术后肌力恢复到M4,2例肌力恢复到M3,屈肘角度50°~110°,平均91°。患者术前、术后肌力比较,差异有统计学意义(t=9.34,P0.05)。根据远端固定2种方式,采用多元T统计分析2组肌力、屈肘力量、角度恢复程度,两者差异无统计学意义(F=1.18,P0.05)。结论采用背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效满意。     

背阔肌肌皮瓣移位重建晚期臂丛神经上千损伤屈肘功能的疗效评价

目的 评价背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效.方法 自2008-01-2013-12采用背阔肌肌皮瓣单极移位法重建9例晚期臂丛神经上千损伤屈肘功能,其中5例将背阔肌远端分别固定于肱桡肌及肱二头肌腱和4例采用传统方法.结果 背阔肌肌皮瓣全部存活,伤口愈合良好,无感染等并发症发生.9例获得随访12～36个月,平均28个月.7例术后肌力恢复到M4,2例肌力恢复到M3,屈肘角度50°～110°,平均91°.患者术前、术后肌力比较,差异有统计学意义(t =9.34,P＜0.05).根据远端固定2种方式,采用多元T统计分析2组肌力、屈肘力量、角度恢复程度,两者差异无统计学意义(F =1.18,P＞0.05).结论 采用背阔肌肌皮瓣移位重建晚期臂丛神经上千损伤届肘功能的疗效满意.     

背阔肌肌皮瓣重建断臂再植肢体屈肘屈指功能

[目的]探讨上臂离断肢体再植术后患者应用改良的背阔肌肌皮瓣移位术,重建屈肘、屈指功能的临床疗效。[方法]2008～2012年,作者对上臂离断再植成活、运动功能无法恢复的患者4例,应用带血管神经蒂的背阔肌肌皮瓣移位重建屈肘、屈指功能同时,取阔筋膜重建肘部滑车结构,二期手术腕关节、拇指掌指关节融合,术后评定重建手术的疗效。[结果]随访8～25个月,术后皮瓣全部成活,4例患者主、被动伸肘均为0°,主动屈肘最大达115°～125°,屈肘时肘部移位的背阔肌无明显弓弦样改变,移植背阔肌肌力达IV级,屈指时2～5指指尖距远侧掌横纹0～3 cm,患侧肩背部功能未见明显异常。[结论]应用改良的背阔肌肌皮瓣移位术是重建上臂离断肢体再植术后屈肘、屈指功能的有效方法。     

同侧颈7移位修复臂丛上干不全损伤的疗效与背阔肌功能的关系

目的：分析用同侧颈7移位治疗臂丛上干不全损伤的疗效与背阔肌功能的关系，方法：1997例3月至2000年9月，对9例臂丛神经上干损伤或上，中干不全损伤伴膈神经损伤患者采用同侧颈7移位于上干前股以恢复屈肘功能，术前检查伤侧背阔肌肌力，并在术后分析疗效时观察同侧颈7移位与背阔肌肌力的关系。结果：6例术前背阔肌肌力正常者作同侧颈7移位于上干前股后，伤侧屈肘功能均得到恢复，3例术前背阔肌肌力减退或肌力消失者，术后屈肘功能均未恢复。结论：臂丛神经上，中干不全损伤时如伤侧背阔肌肌力减退或肌力消失时，不应选择同侧颈7作动力神经。     

指浅屈肌移位重建屈肘功能

目的介绍应用指浅屈肌移位治疗臂丛Ｃ５～７根性撕脱伤患者肘关节屈曲功能障碍的方法。方法在研究１１具成人新鲜上肢标本屈肌腱局部解剖学基础上，对９例不可逆臂丛损伤施行指浅屈肌翻转移位术以重建屈肘功能。结果指浅屈肌７６％的血液供应及６９％的神经支配集中于指浅屈肌起点以远１２ｃｍ的肌腹内。保护好这段肌腹的血供及神经，则肌肉的翻转移位是安全的。临床应用９例，术后平均随访１５个月，肌力恢复到４级以上６例，３级２例，２级１例，满意率达８９％。屈肌腱移位后对手指原有的屈曲功能无明显影响。结论在不可修复的臂丛上干损伤，同侧背阔肌、胸大肌及尺侧腕屈肌不具备移位条件时，用指浅屈肌腱翻转重建屈肘功能，为安全可靠、行之有效的方法。     

背阔肌肌皮瓣移位重建屈肘屈指功能

背阔肌肌皮瓣移位重建屈肘屈指功能敢世廉＊费起礼＊李寅生＊我科自１９８６年１月～１９９２年６月，采用背阔肌肌皮瓣移位重建屈肘、屈指功能共６例，收到满意疗效。报道如下。１临床资料本组男５例，女１例。年龄１０～３８岁，平均２２岁。重建屈肘功能４例，其中肌皮...     

Restoration of elbow function in severe brachial plexus paralysis via muscle transfers

SUMMARY: Reconstruction of elbow function in severe or late brachial plexus injuries represents a challenge to the reconstructive microsurgeons. The current sophisticated techniques of nerve reconstruction in combination with secondary local or free functional muscle transfers, may offer satisfactory outcome. Latissimus dorsi can be transferred as a pedicled or free muscle to restore elbow function. We present our experience with elbow reanimation in late cases of brachial plexus paralysis utilising latissimus dorsi muscle transfer. From 1998 to 2006 we operated 103 patients with brachial plexus paralysis. Amongst these patients, 21 were late cases and underwent latissimus dorsi muscle transfer for elbow reanimation. Ten patients had free latissimus dorsi transfer for elbow flexion. Free latissimus dorsi muscle was neurotised either directly via three intercostals in three patients or with a nerve transfer procedure using the contralateral seventh cervical nerve root in seven patients. Care was taken to maintain the proper tension to the muscle, which must hold the elbow in static flexion of about 120 degrees at the end of the procedure. Powerful elbow flexion (M4-M4+) or extension (M4) was obtained after the first 3 months in all patients who had an ipsilateral pedicled latissimus dorsi transfer. In the group of free muscle transfers, elbow flexion was seen after 6-8 months. After the initiation of muscle contraction, eight of the patients regained elbow flexion of M3-M4+. Latissimus dorsi muscle transfer is a reliable method for elbow reanimation. Appropriate postoperative management is also an important factor to obtain better outcome.     

Restoration of elbow function with pedicled latissimus dorsi myocutaneous flap transfer

Restoration of elbow function is a challenge for orthopaedic surgeons, and many procedures have been described. This study reviewed 17 patients who underwent latissimus dorsi myocutaneous flap transfer for functional reconstruction of elbow flexion or extension. Of the 10 patients who underwent reconstruction for elbow flexion, grade 4 strength of elbow flexion by manual muscle testing was obtained in 8 and grade 3 was obtained in 2. Mean postoperative active elbow flexion was 111 degrees . Of the 7 patients who underwent reconstruction for elbow extension, grade 4 strength of elbow extension was obtained in 3, grade 3 was obtained in 3, and grade 2 was obtained in 1. The 3 patients showing unsatisfactory restoration of flexion or extension strength had associated preoperative weakness of the latissimus dorsi muscle. Preoperative assessment of the latissimus dorsi muscle was most important for obtaining satisfactory results, because preoperative muscle strength influenced the postoperative functional outcome.     

The latissimus dorsi musculocutaneous flap for extremity reconstruction in orthopedic surgery

The latissimus dorsi was transferred as a pedicle flap in ten patients and as a free vascular flap in ten others for extremity reconstruction. Group I comprised ten patients in whom the transfer was used solely to cover a skin or soft-tissue defect. Although there was partial necrosis of the transferred skin in one patient, the remaining nine patients obtained complete coverage without further reconstructive surgery. Group II comprised five patients in whom transfer of the latissimus dorsi was performed for active flexion or extension of the elbow or for abduction of the shoulder. Postoperatively, muscle strength obtained was classified from Grades 0 to 5 according to the muscle testing method. Three patients obtained muscle strength of Grade 3, while two obtained Grade 2. Group III comprised five patients who had brachial plexus palsy after high-dose irradiation. Coverage of the skin and soft tissue was performed after neurolysis of the brachial plexus palsy to free the tissue bed of scarred tissue. Postoperatively, sensory and motor disturbances were alleviated in four of five patients.     

Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption

Five patients between 10 and 46 years old were reviewed after a latissimus dorsi muscle transfer to restore elbow flexion. Loss of elbow flexion resulted from traumatic brachial plexus paralysis in all five patients. All had some weakness in other muscle groups in the upper extremity. The follow-up period was from 25 to 68 months (average = 39.4 months). A range of motion of 0 degrees/115 degrees, 10 degrees/100 degrees, 0 degrees/110 degrees, 0 degrees/70 degrees was obtained. After the transfer, three patients could supinate the forearm, and supination of 90 degrees, 15 degrees, and 10 degrees was measured. Two patients could lift 4 lb, while two others could lift 1 and 1.5 lb, respectively. Evaluation of activities of daily living by a standardized test revealed disappointing results. The two patients with less than 90 degrees elbow flexion had initial paralysis of the latissimus dorsi muscle at the time of injury. This procedure should not be done unless the latissimus dorsi muscle is normal.     

Functional latissimus dorsi island pedicle musculocutaneous flap to restore finger function

Functional latissimus dorsi island pedicle musculocutaneous flaps were used to restore flexion or extension of the wrist and digits in four clinical cases. By retaining the fascial origin of the latissimus dorsi from the posterior crest of the ilium, the entire muscle was transferred without dividing its neurovascular pedicle and microneurovascular anastomoses. Its facial origin successfully reached the finger flexor or extensor muscles of the forearm. The latissimus dorsi muscle was sutured to the digital flexor tendons in three patients and connected to the extensor tendons in one patient. All transfers restored active finger flexion or extension.     

Elbow flexion restoration using pedicled latissimus dorsi transfer in seven cases

PurposeThe aim of this study is to analyse the results of a series of pedicled latissimus dorsi transfers to restore elbow flexion. Moreover, we describe a new technique of distal fixation of the muscle to the proximal third of the ulnar diaphysis to increase the lever arm and improve strength.MethodsWe retrospectively reviewed seven patients aged from 18 to 49 years. Elbow flexion paralysis was secondary to destruction of the anterior arm compartment in four cases and to brachial plexus palsy in three cases. The humeral insertion of the latissimus dorsi was relocated on the coracoid process in five cases and not relocated in two cases. The patients were assessed using the Medical Research Council grading system, the maximum weight lifted by the wrist and the active elbow range of motion.ResultsAt the last follow-up (mean 26.6 months), five patients recovered M4 elbow flexion strength (0.5 to 8 kg), one patient recovered M3 strength and the last transfer failed because of triceps brachii co-contractions. The mean active elbow flexion was 91° (range, 45 to 130°). Patients with destruction of the anterior arm compartment and particularly whose forearm was not paralyzed had better strength than patients with a brachial plexus palsy (3.25 versus 1 kg). A skin island with the latissimus dorsi muscle flap was particularly useful in case of arm soft tissue defect.DiscussionA destroyed anterior compartment of the arm is a good indication for latissimus dorsi transfer to restore elbow flexion. The muscle is usually too weak in high brachial plexus palsy. Finally, the latissimus dorsi needs an objective, reproducible and reliable preoperative evaluation.Level of evidenceLevel IV.     

The latissimus dorsi flap for reconstruction of the brachium and shoulder

The latissimus dorsi was transferred on its neurovascular pedicle to reconstruct the shoulder or brachium in nineteen patients. Group I consisted of seven patients in whom transfer of the latissimus dorsi was used only to obtain active flexion of the elbow. Although there was complete necrosis of the transferred muscle in one patient, six patients achieved an average of 111 degrees of active flexion and full extension of the elbow. There was only a modest gain in active supination because of pre-existing pronation contractures. The three patients in Group II had sustained loss of the flexor muscles of the elbow and the overlying soft tissue as a result of trauma. After the latissimus dorsi musculocutaneous flexorplasty, an average of 135 degrees of active flexion of the elbow was restored, but there was an average loss of 12 degrees of extension. The three patients in Group III had a large, noninfected defect of the soft tissue over the shoulder or brachium; the bone, shoulder joint, or neurovascular structures were exposed in each patient. Transfer of the latissimus dorsi with the overlying skin provided satisfactory coverage of the defect. The six patients in Group IV had chronic osteomyelitis or septic arthritis of the glenohumeral joint. Treatment consisted of radical débridement of the infected soft tissue and bone followed by transfer of the latissimus dorsi. This provided satisfactory coverage for subsequent osteosynthesis of the humerus or arthrodesis of the shoulder when one of these procedures was indicated. At the time of writing, an average of 2.3 years after the latissimus dorsi transfer, none of the patients in this group (including one who died nine months post-operatively of unrelated causes) had drainage.