Kim D H, Glazer P A
Harvard Combined Orthopaedics Residency Program, and the Boston Orthopaedics Group, Boston, Massachusetts 02446, USA.
Spine (Phila Pa 1976). 2000 Mar 1;25(5):622-5. doi: 10.1097/00007632-200003010-00014.
A report of a patient in whom progressive symptomatic thoracolumbar scoliosis developed after breast reconstruction with a latissimus dorsi myocutaneous flap.
To present the first reported case of progressive symptomatic scoliosis after breast reconstruction with a latissimus dorsi myocutaneous flap and to suggest that latissimus flap harvest may be contraindicated in patients with preexisting scoliosis.
Latissimus dorsi myocutaneous flap harvest incorporated into several surgical operations including breast reconstruction has been presented as a relatively benign procedure without significant biomechanical consequence. Nevertheless, various anatomic and animal studies have suggested an important role for balanced latissimus function in terms of proper spinal alignment. Long-term follow-up evaluation of patients after latissimus flap harvest is insufficient and fails to address the specific issue of spinal deformity.
Postoperative radiographs demonstrated significant progression of the patient's thoracolumbar scoliosis as compared with radiographs taken before her latissimus harvest. Curve progression accompanied by development of severe and disabling back pain were considered indications for surgical curve correction and stabilization.
At the time of 1-year follow-up assessment after posterolateral spinal fusion and instrumentation, the patient had experienced complete relief from her back pain and satisfactory spinal fusion.
Although a cause and effect relation cannot be established, this case study suggests that latissimus harvest may have a destabilizing effect on the thoracolumbar spine in the long term, especially in patients with preexisting scoliosis. Alternative procedures should be considered in these patients.
一份关于一名患者的报告，该患者在采用背阔肌肌皮瓣进行乳房重建后出现了进行性症状性胸腰椎侧弯。
呈现首例关于采用背阔肌肌皮瓣进行乳房重建后出现进行性症状性脊柱侧弯的报告，并提示对于已有脊柱侧弯的患者，背阔肌皮瓣切取术可能为禁忌。
背阔肌肌皮瓣切取术已被纳入包括乳房重建在内的多种外科手术中，被视为一种相对良性的手术，不会产生显著的生物力学后果。然而，各种解剖学和动物研究表明，背阔肌功能的平衡在脊柱正常排列方面具有重要作用。对接受背阔肌皮瓣切取术患者的长期随访评估不足，且未涉及脊柱畸形这一具体问题。
术后X线片显示，与切取背阔肌之前拍摄的X线片相比，该患者的胸腰椎侧弯有显著进展。侧弯进展并伴有严重且致残性背痛被视为手术矫正和稳定侧弯的指征。
在进行后外侧脊柱融合及内固定术后1年的随访评估时，患者的背痛已完全缓解，脊柱融合情况良好。
尽管无法确定因果关系，但本病例研究提示，长期来看，切取背阔肌可能会对胸腰椎产生不稳定作用，尤其是对于已有脊柱侧弯的患者。对于这些患者，应考虑采用其他手术方法。
