大鱼际逆行皮瓣临床应用及拇指感觉恢复效果评估

Clinical application of reverse greater thenar flaps and its effect on sensory function recovery of thumbs

  • 摘要: 目的 研究大鱼际逆行皮瓣的临床应用及利用不同神经所形成的有感觉皮瓣的感觉恢复情况。 方法 2006年5月-2010年8月,解放军第252医院及保定市第一中心医院共43例拇指部分缺损患者(年龄17-52岁)根据具体伤情行3种不同的大鱼际皮瓣修复术,皮瓣的最大切取面积为3.5cm×4.0cm,最小1.5cm×2.0cm。其中33例同时行神经移位,分别利用桡神经浅支及正中神经掌皮支恢复拇指感觉。术后随访0.5-2年,平均10个月,对3种皮瓣的成活率、血运与质地、拇指功能进行评定,并对不同神经移位的皮瓣感觉恢复情况进行比较。 结果 临床43例皮瓣均成活,血运良好、质地柔软、弹性好;拇指关节及骨质无缺损的患者拇指功能恢复均为优;未行神经移位的10例患者中6例感觉恢复为S2,4例为S1;桡神经浅支移位组3例感觉恢复为S3,16例达S3+,而正中神经掌皮支移位组9例感觉恢复为S3,5例达S3+,前者优于后者(P<0.05)。 结论 几种大鱼际皮瓣适当选择、灵活应用,可以很好地修复拇指缺损,大鱼际皮瓣利用桡神经浅支恢复感觉效果优于正中神经掌皮支。

     

    Abstract: Objective To study the clinical application of reverse greater thenar flaps and the effect of different flaps with nerves on sensory function recovery of thumbs. Methods Forty-three patients aged 17-52 years with partial defects of thumb who underwent three kinds of reverse greater thenar flap in May 2006-August 2010 in Baoding First Central Hospital and Chinese PLA 252 Hospital were divided into group A(n=14),group B(n=14),and group C(n=15).The maximum and minimum size of flaps was 1.5cm×2.0cm and 3.5cm×4.0cm respectively.Of the 43 patients,33 underwent reverse flap transplantation and nerve transposition.Reverse flaps with superficial branches of radial nerve and palmer branches of median nerve were transplanted to recover the sensory function of their thumbs.The patients were followed up for 0.5-2 years(mean 10 months).The survival rate,blood circulation and texture,sensory function recovery of thumbs after transplantation of 3 different flaps were assessed and compared. Results All the transplanted flaps survived with good blood circulation,soft texture,and good elasticity.The sensory function of thumbs was completely recovered.Of the 10 patients who did not undergo nerve transposition,6 had their sensory function of thumbs recovered as S2 and 4 as S1.Of those who underwent flap transplantation with superficial branches of radial nerve,3 had their sensory function of thumbs recovered as S3 and 16 as S3+.Of those who underwent flap transplantation with the palmer branches of median nerve,9 had their sensory function of thumbs recovered as S3 and 5 as S3+(P<0.05). Conclusion Reverse greater thenar flaps can repair the defects of thumbs.The effect of reverse flap transplantation with the superficial branches of radial nerve is better than that of reverse flap transplantation with the palmer branches of median nerve.

     

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