Stern P J, Carey J P
University of Cincinnati College of Medicine, Ohio.
J Bone Joint Surg Am. 1988 Apr;70(4):526-35.
The latissimus dorsi was transferred on its neurovascular pedicle to reconstruct the shoulder or brachium in nineteen patients. Group I consisted of seven patients in whom transfer of the latissimus dorsi was used only to obtain active flexion of the elbow. Although there was complete necrosis of the transferred muscle in one patient, six patients achieved an average of 111 degrees of active flexion and full extension of the elbow. There was only a modest gain in active supination because of pre-existing pronation contractures. The three patients in Group II had sustained loss of the flexor muscles of the elbow and the overlying soft tissue as a result of trauma. After the latissimus dorsi musculocutaneous flexorplasty, an average of 135 degrees of active flexion of the elbow was restored, but there was an average loss of 12 degrees of extension. The three patients in Group III had a large, noninfected defect of the soft tissue over the shoulder or brachium; the bone, shoulder joint, or neurovascular structures were exposed in each patient. Transfer of the latissimus dorsi with the overlying skin provided satisfactory coverage of the defect. The six patients in Group IV had chronic osteomyelitis or septic arthritis of the glenohumeral joint. Treatment consisted of radical débridement of the infected soft tissue and bone followed by transfer of the latissimus dorsi. This provided satisfactory coverage for subsequent osteosynthesis of the humerus or arthrodesis of the shoulder when one of these procedures was indicated. At the time of writing, an average of 2.3 years after the latissimus dorsi transfer, none of the patients in this group (including one who died nine months post-operatively of unrelated causes) had drainage.
19例患者采用背阔肌带神经血管蒂转移术重建肩部或上臂。第一组7例患者，仅利用背阔肌转移来实现肘关节的主动屈曲。尽管1例患者转移的肌肉完全坏死，但6例患者肘关节平均获得111度的主动屈曲和完全伸直。由于术前存在旋前挛缩，主动旋后仅略有增加。第二组3例患者因外伤导致肘关节屈肌及上方软组织持续缺失。背阔肌肌皮屈肌成形术后，肘关节平均恢复135度的主动屈曲，但平均伸直丧失12度。第三组3例患者肩部或上臂存在大的、未感染的软组织缺损；每位患者的骨骼、肩关节或神经血管结构均有暴露。带上方皮肤的背阔肌转移为缺损提供了满意的覆盖。第四组6例患者患有盂肱关节慢性骨髓炎或化脓性关节炎。治疗包括对感染的软组织和骨骼进行彻底清创，随后进行背阔肌转移。当需要进行肱骨接骨术或肩关节融合术时，这为后续手术提供了满意的覆盖。在撰写本文时，背阔肌转移术后平均2.3年，该组患者（包括1例术后9个月因无关原因死亡的患者）均无引流情况。
