乳腺癌术后即刻转移背阔肌皮瓣乳房重建术的手术配合

[目的]总结乳腺癌术后即刻转移背阔肌皮瓣乳房重建术的手术配合。[方法]对29例乳腺癌病人行乳腺癌改良根治术,术后即刻应用手部分背阔肌肌瓣转移重建乳房,同时加强术前准备、术中配合和术后护理等。[结果]29例病人背阔肌肌瓣全部成活,患侧上肢功能恢复良好,腋前部饱满,未发生明显并发症;3个月后重建乳房效果评价良好20例,一般7例,差2例。[结论]加强乳腺癌术后即刻转移背阔肌皮瓣乳房重建术的手术配合是手术成功的保证。     

改良背阔肌皮瓣在胸壁缺损中的应用

目的探讨改良背阔肌皮瓣在胸壁缺损中的临床应用效果。方法选择近10年来我院接受胸部胸壁缺损治疗的患者30例,其中15例采用改良的改良背阔肌肌皮瓣进行治疗,另15例采用传统背阔肌(肌)皮瓣术进行治疗,分别以两组患者的并发症发生率、皮瓣存活率及活动舒适度作为临床评价指标,进行比较分析。结果观察组术后并发症发生率仅为6.6%,对照组为46.6%,观察组术后活动舒适度均明显优于对照组,P<0.05,两组患者的术后皮瓣存活率无显著性差别,P>0.05,具有统计学意义。结论改良的窄蒂背阔肌(肌)皮瓣修补术对于胸壁缺损的修补具有术后并发症率低、皮瓣存活率高及活动舒适等优点,值得进行临床推广应用。     

13例乳腺癌术后二期岛状背阔肌肌皮瓣联合假体的乳房再造术病人的护理

[目的]总结乳腺癌术后二期岛状背阔肌肌皮瓣联合假体的乳房再造术病人的护理。[方法]对13例乳腺癌根治术后二期应用岛状背阔肌肌皮瓣联合乳房假体行乳房再造术病人进行心理护理、术前准备、体位护理、饮食护理、皮瓣的观察、引流管及切口的护理。[结果]13例病人术后再造乳房全部成活,供受区切口均Ⅰ期愈合;随访时间3个月～14个月,病人再造乳房外观自然,手感良好,手术效果满意。[结论]加强护理是提高岛状背阔肌肌皮瓣联合乳房假体行乳房再造修复乳腺癌根治术成功的保证。     

背阔肌肌皮瓣乳房再造术治疗乳腺分叶状肿瘤的围手术期护理

目的总结背阔肌肌皮瓣乳房再造术治疗乳腺分叶状肿瘤的围手术期护理要点。方法回顾性分析和总结11例乳腺分叶状肿瘤患者行背阔肌肌皮瓣乳房再造术治疗的护理经过。结果11例乳腺分叶状肿瘤的患者行背阔肌肌皮瓣乳房再造术后,1例乳头坏死、2例乳房局部皮肤坏死、1例背阔肌术区血肿、1例乳房皮下积液,经及时治疗和恰当的护理后均痊愈出院。结论护士进行正确的心理护理、体位护理、伤口护理引、流管护理及康复护理,同时加强并发症的预见性观察和护理是背阔肌肌皮瓣乳房再造术治疗乳腺分叶状肿瘤获得成功的重要保证。     

带蒂背阔肌降支微型肌瓣在保乳术中的临床应用

乳房畸形是传统保乳术后的重要问题。肿瘤整形技术在保证安全的前提下,较大程度上提高了术后乳房的美观度。背阔肌皮瓣具有良好的稳定性和多功能性,被广泛用于保乳术后乳房容量替代的重建手术。背阔肌微型肌瓣较好地解决了术后患肢功能缺陷和供体部位凹陷等问题,临床应用广泛。根据背阔肌的解剖结构,有学者提出采用背阔肌降支微型肌瓣结合假体重建乳房。本文就整形保乳手术以及带蒂背阔肌降支微型肌瓣在保乳术中的临床应用作一综述。     

乳腺癌改良根治术后即刻背阔肌肌皮瓣移植重建乳房：42例分析

背景：在根治肿瘤的同时如何保持女性乳房的形态完美这一问题得到了越来越多医生及患者的关注,乳房再造由此而产生、发展,逐渐成为乳腺癌治疗的重要组成部分。目的：探讨乳腺癌改良根治术后即刻背阔肌肌皮瓣移植重建乳房的可行性及疗效。方法：纳入42例女性单侧乳腺癌患者,均进行保留乳头乳晕或保留乳房的改良根治术,术后即刻自体背阔肌皮瓣或扩大背阔肌肌皮瓣移植重建乳房,根据客观标准及主观标准评价重建效果。结果与结论：42例中,33例行保留乳头乳晕的乳腺癌改良根治术、9例行保留皮肤的乳腺癌改良根治术,背阔肌乳房重建24例、扩大背阔肌乳房重建18例。转移皮瓣及重建的乳房全部成活,无严重并发症发生。客观评价美容效果优良39例,一般3例;主观评价优良者40例,尚可者2例。随访9-41个月,所有患者无肿瘤局部复发,1例出现骨转移。表明乳腺癌改良根治术后即刻采用背阔肌移植重建乳房操作简单、易行,整形效果好,安全性高,成活率高。     

基于穿支皮瓣理念改良设计背阔肌瓣游离移植修复下肢皮肤软组织缺损

背景:尽管胸背动脉穿支皮瓣能减轻供区损伤和避免受区臃肿,但是由于分离穿支相当费时,有人认为仅限于经验丰富医生并主张保留部分肌肉组织.目的:探讨应用穿支皮瓣理念设计的背阔肌皮瓣游离移植修复下肢的移植方案及其修复效果.方法:纳入17例需要皮瓣移植的患者,12例背阔肌肌(皮)瓣,3例保留部分肌袖的背阔肌瓣和2例分叶背阔肌组织瓣均采用穿支皮瓣理念设计,根据胸背动脉的供血范围,皮瓣靠前设计,以供区能直接拉拢缝合为度,切取时将胸背动脉外侧支的皮穿支包含在内.必要时可再向内侧切除背阔肌肌瓣以扩大移植组织块面积,有时为了修复两个相邻部位的缺损,可切取保留部分肌袖的背阔肌瓣和以胸背动脉外侧支营养的部分背阔肌肌瓣并形成分叶背阔肌组织瓣.组织瓣切取范围12 cm×8 cm～28 cm×17 cm.观察患者皮瓣移植后成活情况、皮瓣供区和受区的外形及功能.结果与结论:皮瓣移植后1例血管危象发生,探查重新吻合血管后危象解除,所有皮瓣均成活;1例肌瓣植皮部分坏死,二期植皮修复;供区创面均直接拉拢缝合.15例患者随访3～18个月,其中2例皮瓣外形臃肿,影响穿鞋,二期行皮瓣修薄术.提示应用穿支皮瓣理念设计背阔肌瓣能有效减轻供区损伤和受区臃肿畸形,分叶背阔肌组织瓣能较好修复足底和足尖两处软组织缺损,结合穿支皮瓣理念、个性化设计不同形式的背阔肌瓣可满意修复较大下肢皮肤软组织缺损.     

Biomechanics of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears

Background

Latissimus dorsi transfer is the treatment most frequently used for restoring function in shoulders with irreparable posterosuperior rotator cuff tears. Yet, functional outcomes of the transfers are unpredictable and vary among patients.

Methods

A three-dimensional upper-extremity computational model was used to simulate and analyze the biomechanical consequences of transferring the latissimus dorsi to four attachment sites: the infraspinatus, supraspinatus, subscapularis and teres minor insertions. Functions of a normal shoulder were simulated, as well as those and of a shoulder with a posterosuperior rotator cuff tear before and after muscle transfers were simulated. Parameters such as active and passive moment-generating capacity, and the moment arm and fiber excursion ratio of the transferred muscle were analyzed.

Findings

All muscle transfers resulted in a large increase in shoulder external rotation strength. The latissimus dorsi was an external rotator after the transfer, but the fiber excursion ratio decreased accordingly. When the latissimus dorsi was transferred to the infraspinatus, supraspinatus or subscapularis insertion, it changed from extensor to flexor at the beginning of flexion. The flexion moment arm of the latissimus dorsi after the transfers was generally decreased. Shoulder abduction strength did not improve. Decrease in fiber excursion ratio during abduction and flexion was observed after the transfer. Side effects of the muscle transfers, such as the reduction of active adduction, extension and internal rotation of the shoulder, were explored.

Interpretation

A transfer to teres minor insertion was not recommended. Infraspinatus insertion was found to be a preferred attachment site in latissimus dorsi transfer, provided that the patient had a strong deltoid.     

Breast reconstruction

The majority of women who are undergoing mastectomy can also have breast reconstruction. In most breast units, implants and latissimus dorsi flaps can be performed. The more sophisticated transverse rectus abdominis myocutaneous (TRAM) flap-based reconstructions are generally performed by plastic surgeons so that there may be logistic problems in using these techniques for immediate reconstruction. Decisions on technique will also depend on the patient's build and co-existing medical conditions together with the likelihood of need for postoperative radiotherapy as part of the primary local treatment.     

不同类型血供轴型皮瓣轴心动脉超声显像的探讨

目的 探讨不同类型血供轴型皮瓣轴心动脉的超声显像。 方法 各型临床待转位或移植轴型皮瓣21例，术前超声检测轴心动脉的起源、走向，并做体表定位，声像图表现与手术显露血管蒂对照。 结果 直接皮血管型：侧胸皮瓣3例，超声检出轴心动脉源于肩胛下动脉和胸背动脉，浅出深筋膜，平行皮肤走行。肌皮血管型：背阔肌肌皮瓣5例，腹直肌肌皮瓣2例，声像图显示轴心动脉分别沿背阔肌、腹直肌走行并进入肌内。肌问隙皮血管型：隐动脉皮瓣4例，小腿内侧中下部皮瓣6例，声像图显示轴心动脉走行于回声不同的肌块问。主干带小分支型：小腿前部皮瓣1例，轴心动脉为粗大胫前动脉及其所带皮支。声像图探测各轴心动脉的位置与手术所见一致。 结论 肌肉与动脉关系有助于超声辨认肌皮血管型、肌间隙皮血管型皮瓣轴心动脉；聚焦皮下组织有助于超声辨认直接皮血管型轴心动脉。主干带小分支型皮瓣轴心动脉超声显像不难。     

岛状背阔肌肌皮瓣乳房再造加腋前皱襞重建术的护理配合

目的探讨乳腺癌根治术后Ⅱ期应用岛状背阔肌肌皮瓣加乳房假体行乳房再造术及腋前皱襞重建手术的护理配合。方法回顾性总结13例乳腺癌根治术后1—4年胸壁严重缺损患者行Ⅱ期岛状背阔肌肌皮瓣加乳房假体行乳房再造术及腋前皱襞重建的手术配合,包括术前人员、器械、物品及病人的准备,术中护士的配合方法。结果13例手术均获得成功,未发生由于器械或配合不良耽误手术,术中、术后皮瓣成活,切口无感染、均Ⅰ期愈合,无并发症发生,乳房外形良好,患者满意。结论术前物品准备充分及做好心理护理,取得患者的最佳配合;术中熟练的手术配合技巧是手术顺利完成的重要保证。     

Shoulder muscle activity during the modified dynamic relocation test and side-lying shoulder external rotation: a cross-sectional study on asymptomatic individuals

Objectives: (1) to compare activity levels between monitored muscles during the dynamic relocation test (DRT); (2) to assess changes in muscle activation variability over 10 trials; (3) to assess within-muscle difference activity levels between the DRT and the unloaded side-lying shoulder external rotation exercise.

Methods: This is a cross-sectional, laboratory-based, repeated measures study. Thirty asymptomatic individuals performed the DRT and unloaded side-lying external rotation. The order of exercises was randomized. Superficial electromyography was used for recording the supraspinatus, infraspinatus, middle deltoid, posterior deltoid, pectoralis major, and latissimus dorsi muscles. The main outcome measures were mean muscle activity, expressed as % of maximal isometric voluntary contraction.

Results: We found significant between-muscles differences in activity (F_t = 14.11, p < 0.001) during the DRT. Post hoc analysis suggested between-trial variability did not change over the 10 trials, (F = 18.2, p < 0.001). Within-muscle comparisons between the DRT and side-lying shoulder external rotation suggested significant differences between these exercises (F = 32.37, p < 0.001).

Conclusions: considering the monitored muscles, supraspinatus, infraspinatus, pectoralis major, and latissimus dorsi are the main muscles contracting during the DRT. Of all monitored muscles, supraspinatus muscle was the only one presenting higher activity levels during the DRT when compared to the unloaded side-lying shoulder external rotation.     

The Effects of Different Gait Speeds and Lower Arm Weight on the Activities of the Latissimus Dorsi,Gluteus Medius,and Gluteus Maximus Muscles

[Purpose] This study researched the effects of different gait speeds and lower arm weight on the activities of the latissimus dorsi, gluteus medius, and gluteus maximus muscles. [Subjects] Fourteen healthy adult men participated in this study. [Methods] All the participants carried out walking on a treadmill at speeds of 3.5 km/h and 5.5 km/h for half a minute. During treadmill gait, electromyographic activity muscle was measured of the latissimus dorsi, gluteus medius and gluteus maximus. [Result] There were significant differences in the muscle activities due to changes in gait speed and lower arm load in the latissimus dorsi and gluteus maximus, but there were no significant differences in the muscle activities of the gluteus medius. [Conclusion] According to our results, arm swing is related to increasing gait speed, and lower arm load is influences the muscle activity of the lower extremities through the posterior oblique sling system.Key words: Posterior oblique sling system, Arm weight, Arm swing     

彩色多普勒超声在胸背动脉穿支移植皮瓣的临床应用

目的　评价彩色多普勒超声在探测胸背动脉穿支移植皮瓣中的临床应用价值。方法　对拟行胸背动脉穿支皮瓣的31例患者,术前应用彩色多普勒超声进行检查,观察记录胸背动脉及其穿支的走行、内径、距体表的距离,并将其标志于体表。结果　31例胸背动脉均可探及,显示率为100%,其中30例胸背动脉可探及穿支血管,1例因血管内径细窄、走行迂曲、变异,改行其他部位的皮瓣移植。结论　彩色多普勒超声检测胸背动脉可为临床提供了一个经济、可靠、无创并能够体表定位胸背动脉及其穿支皮瓣的方法。     

Breast reconstruction: current state of the art

The current state of the art makes breast reconstruction possible in any patient who has undergone mastectomy, whether simple, modified radical, or radical. Indications for reconstruction are a strong desire on the part of the patient and a reasonable life expectancy. Methods of reconstruction include the simple placement of a breast prosthesis alone (submuscularly when possible) or in combination with advancement of upper abdominal skin or rotation flaps. Expander implants are useful in patients with limited skin and musculature. For the patient with serious muscle and skin deficits, more complex reconstructive procedures with use of transverse rectus abdominis or latissimus dorsi myocutaneous flaps may be performed, with or without an implant. Several methods of reconstruction of the nipple and areola are also possible. Treatment of the opposite breast is often necessary if symmetry is to be achieved. When appropriate, augmentation, mastopexy, reduction, or subcutaneous mastectomy may be performed. There is no single preferred method of reconstruction. The approach should be tailored for each patient.     

扩大背阔肌肌皮瓣在晚期乳腺癌改良根治术的应用

目的探讨乳腺癌改良根治术后应用扩展型背阔肌肌皮瓣修复手术创面的疗效。方法10例晚期乳腺癌患者在乳腺癌改良根治术后,均采用以背阔肌肌皮瓣及胸背动脉营养的脂肪组织联合移位来修复手术创面。结果10例患者手术全部成功,经过6个月～3年随访,术后效果满意。结论扩大背阔肌肌皮瓣移位修复创面,克服了传统背阔肌肌皮瓣组织量不足的缺点,手术操作不复杂,成功率高,不失为一种较好的手术方法。     

Association of thoraco-lumbar fascia length in individuals with non-specific low back pain - an observational study

ObjectiveThe purpose of the study was to assess the length of TLF and to evaluate the strength of muscles attached to it in subjects with and without nonspecific low back pain (NSLBP).Methods31 patients with NSLBP and 31 healthy individuals were included in the study. In each subject the TLF length was assessed by quantifying lumbar rotation using Back range of motion (BROM-II) instrument. The endurance of transverses abdominis was assessed using the pressure biofeedback unit while the strength of Latissimus dorsi, internal and external oblique's were assessed using MMT. Outcome measure such as Range of Motion (ROM) was compared across the group using independent sample T-test. While the muscle strength of Latissimus dorsi and oblique's were compared across the group using Man-whitney U- test. Transverse abdominis endurance was tested using chi-square test.ResultsThere was statistically significant difference in the length of TLF of subjects with NSLBP when compared with subjects without NSLBP. When the strength of Latissimus dorsi muscle, transverses abdominis muscle and internal and external oblique's muscle was assessed no significant (p value > 0.05) difference was found in either group.ConclusionsThere was statistically significant reduction in length of TLF but there was no difference in the strength of Latissimus dorsi, internal and external oblique's or endurance of transverses abdominus attached to the TLF in individuals with NSLBP and without low back pain. This study will help in determining the inclusion of TLF and the associated structures in evaluation and management of subjects with NSLBP.     

Acute somatic pain can refer to sites of chronic abdominal pain

We report a case of a latissimus dorsi muscle strain that presented as a recurrence of chronic abdominal pain. One explanation of the referral of acute pain to a site of chronic pain is the convergence-projection theory, which hypothesizes that pain signals of visceral and somatic origin converge at some point in the sensory pathway. Upon reaching the cortex, these signals are interpreted as coming from the afferents which have previously excited this pathway. In this case an extensive gastrointestinal diagnostic evaluation was pursued unsuccessfully before the latissimus dorsi muscle strain was diagnosed. Outpatient therapy of spray and stretch combined with a home stretching program produced a prompt and persistent resolution of the symptoms.     

乳腺癌改良根治乳房重建术后患者上肢功能锻炼的效果观察

目的探讨乳腺癌改良根治术加即刻背阔肌肌皮瓣乳房重建术后患者采用拉力器及哑铃进行患侧上肢后伸、旋内、内收功能锻炼的效果。方法将60例乳腺癌改良根治术加即刻背阔肌肌皮瓣乳房重建术后患者随机分为观察组和对照组各30例,对照组按乳腺癌手术护理常规进行功能锻炼,由护士向患者一对一讲解并示范渐进式患侧功能锻炼的方法,并在家属协助下由患者自行锻炼;观察组在对照组的基础上针对丧失的背阔肌功能采用拉力器及哑铃进行更为系统的患侧内收、后伸、旋内运动锻炼。于术后第30天、第60天时观察比较两组后伸、旋内角度及内收肌力。结果两组患者术后第30天、第60天患侧上肢运动功能情况比较,差异有统计学意义(P<0.01),观察组后伸、旋内角度及内收肌力均大于对照组。结论针对丧失的背阔肌功能采用拉力器及哑铃进行系统的患侧内收、后伸、旋内运动有利于乳腺癌改良根治乳房重建术后患者患侧背阔肌功能恢复。