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。

Recovered latissimus dorsi musculocutaneous flap for reconstruction of flexor of elbow or digits

[Objective]To discuss the result of using latissimus dorsi musculocutaneous flap which function was recovered by repairing the thoracodorsal nerve with nerve transfering for reconstruction of flexor of elbow or digits in brachial plexus injury patients.[Method]From march 2000 to June 2003,eight patients with brachial plexus total roots avulsion were treated by mlutiple donor nerves transfer.The function of latissimus dorsi muscle recorved well but not the biceps muscle in five patients.The function of flex digits did not recover while the latissimus dorsi muscule recorverd well in three patients.All of them had the aid of latissimus dorsi musculocutaneous flap to reconstruct the flexor of elbow or digits.[Result]The patients were followed up for one year to half past three years,all of musculocutaneous flap were survived,the muscle strenght graded 3 to 4 and the active motion of the elbow was over 100 degrees in flexion and 10 degrees to 25 degrees in extension.All the digits can grasp,the fist closure was about 2 cm and the muscle strenght was grade 3 of the involved digits.[Conclusion]It is a good method to reconstruct the flexor of elbow or digits by the recovered latissimus dorsi musculocutaneous flap in brachial plexus total roots avulsion patients.When treating brachial plexus total roots avulsion patients,it is necessary to repair the thoracodorsal nerve.