Ueda K, Harii K, Yamada A
Department of Plastic Surgery, University of Tokyo, Japan.
Plast Reconstr Surg. 1995 Feb;95(2):296-304. doi: 10.1097/00006534-199502000-00009.
The functional recovery of gracilis muscles grafted for treatment of facial paralysis in combination with a cross-face nerve graft was evaluated on the basis of electromyography in 98 cases. Initial action potentials were recorded, on average, 8 months after transplantation. There was a tendency for such potentials to appear earlier in the case of patients who finally attained good muscle activity. Action potentials were polyphasic in the early stage and of short duration and low amplitude. An increase in the amplitude and duration of potentials and a shortening of the distal latency were observed with increase in the numbers of reinnervated muscle fibers. Thereafter, there was a tendency toward decreases in the duration and number of spikes due to the increasing similarity in the distal latency of each neuromuscular unit. The grafted gracilis muscles attained a stable state about 1 year after the initial recording of action potentials. It was expected that spontaneous action potentials during rest might serve to indicate the condition of reinnervation. Their absence during the first few months after transplantation may suggest necrosis of the grafted muscle, while those of long duration and high amplitude observed after 1 postoperative year may be suggestive of disturbance in the reinnervation process. In this study, we could not find any significant difference in the reinnervation process between that of a gracilis muscle grafted following a cross-face nerve graft and a muscle reinnervated following nerve transection and repair. We therefore believe that free gracilis muscle transplantation combining a cross-face nerve graft is appropriate for the reconstruction of muscle function.
在98例患者中，基于肌电图评估了移植股薄肌联合跨面神经移植治疗面瘫后的功能恢复情况。平均在移植后8个月记录到初始动作电位。对于最终获得良好肌肉活动的患者，此类电位往往出现得更早。早期动作电位多为多相，持续时间短且波幅低。随着再支配肌纤维数量增加，电位的波幅和持续时间增大，远端潜伏期缩短。此后，由于每个神经肌肉单位远端潜伏期的相似性增加，电位的持续时间和波峰数量有减少的趋势。在记录到动作电位约1年后，移植的股薄肌达到稳定状态。预计静息时的自发动作电位可能有助于指示再支配情况。移植后最初几个月无自发动作电位可能提示移植肌肉坏死，而术后1年出现的持续时间长且波幅高的自发动作电位可能提示再支配过程受到干扰。在本研究中，我们未发现跨面神经移植后移植股薄肌的再支配过程与神经切断和修复后肌肉再支配过程之间存在任何显著差异。因此，我们认为联合跨面神经移植的游离股薄肌移植适用于肌肉功能重建。
