Clinical Application of Functioning Free Muscle Transplantation (FFMT) in the Late Obstetric Brachial Plexus Palsy (OBPP)

臨床應用功能性肌肉瓣轉移重建生產引起之臂神經叢麻痺的後遺症

莊垂慶(David Chwei-Chin Chuang) ； 鄭明輝(Ming-Huei Cheng) ； 馬海霞(Hae-Shya Ma)

《中華民國整形外科醫學會雜誌》 15卷3期 (2006/09) Pp. 211-228

https://doi.org/10.7096/JPSA.200609.0211

摘要

生產引起之臂神經叢麻痺，可分為早期嬰兒期麻痺及晚期孩子期麻痺。後者常有殘存的缺陷，包括：(1)肌肉有功能恢復，但為神經迷走之結果；(2)肌肉麻痺萎縮及(3)原始神經重建後之肌肉功能不全。這些缺陷，用平常傳統的重建方法，常是不夠的，而是需要較複雜的重建方法，比如功能性肌肉瓣轉移(FFMT)。由1997年7月至2002年7月，5年期間，作者共使用65塊FFMT於59位病人身上。有6個病人，接受2塊FFMT重建。重建的對象，包括肘彎曲（39塊），肘伸展（2塊），指伸展（7塊），指彎曲（8塊），用－肌肉同時重建肘彎曲及指伸展（有13塊）。所使用的支配神經包括肋間神經，肌皮神經，脊髓副神經及對側第七頸椎神經。文中均有敘述及引導如何使用FFMT之適應症、方法、結果及最佳手術時間。

並列摘要

Obstetric brachial plexus palsy (OBPP) can be subdivided into initial (or infant) and late (or child) phase of OBPP. In the late phase of OBPP, there are three types of residual deformities: (1) spontaneous motor recovery with aberrant reinnervation, (2) paralysis (complete denervation), or paresis (incomplete reinnervation), and (3) motor recovery following primary nerve reconstruction. Traditional tendon or muscle transfer techniques do not provide satisfactory reconstruction for those deformities, and these patients require more complex techniques such as functioning free muscle transplantation (FFMT). The incidence is about 8%. Between July 1997 and July 2002 (a 5-year period) 59 late phase of OBPPs were reconstructed with 65 FFMTs at Chang Gung Memorial Hospital by the same surgeon (DCC Chuang). Six patients had two FFMTs for reconstruction of the different deficits. The function restored by the FFMT included elbow flexion (35 FFMTs), elbow extension (2 FFMTs), finger extension (7 FFMTs), fmger flexion (8 FFMTs), finger extension plus elbow flexion by using one muscle (13 FFMTs). The donor transferred nerve used as the muscle neurotizer included spinal accessory nerve, intercostal nerves, musculocutaneous nerve, or contralateral C7 spinal nerve. Guidelines by using FFMT for different deficits in the late phase of OBPP are provided regarding the indications, methods, results and optimum timing of FFMT. (J Plast Surg Asso R.O.C. 2006; 15:211~228)

並列關鍵字

functioning free muscle transplantation ； obstetric brachial plexus palsy