Knopp W, Buchholz J, Muhr G, Steinau H U
Chirurgische Klinik und Poliklinik, BG-Krankenanstalten Bergmannsheil, Universitätsklinik Bochum.
Unfallchirurg. 1993 May;96(5):229-34.
Although local muscle flaps of the lower leg are often used, the functional problems that arise after these reconstructive procedures have not yet been adequately studied. Twenty patients who had undergone a local muscle flap of the lower leg 3 years earlier were studied using a isokinetic muscle test. The isokinetic muscle strength profile during flexion of the foot was reduced by up to 21 +/- 16% after transfer of the m. gastrocnemius and by up to 31 +/- 20% after transfer of the m. soleus at a angular velocity of 120 degrees. The isokinetic muscle strength profile during pronation and supination of the foot at an angular velocity of 120 degrees was reduced by up to 89 +/- 32% after transfer of the m. soleus. Statistically, compound tibia fractures without a local flap for soft tissue therapy showed significantly better results. In view of this functional loss, the use of local muscle flaps, particularly the transfer of the m. soleus, should be restricted in younger patients, and alternative techniques (free flaps) should be used.
尽管小腿局部肌皮瓣经常被使用,但这些重建手术后出现的功能问题尚未得到充分研究。对20例3年前接受过小腿局部肌皮瓣手术的患者进行了等速肌力测试研究。在120度角速度下,腓肠肌转移后足背屈时的等速肌力曲线下降高达21±16%,比目鱼肌转移后下降高达31±20%。在120度角速度下,比目鱼肌转移后足内旋和外旋时的等速肌力曲线下降高达89±32%。统计学上,未使用局部皮瓣进行软组织治疗的胫骨干骨折患者结果明显更好。鉴于这种功能丧失,在年轻患者中应限制使用局部肌皮瓣,尤其是比目鱼肌转移,而应采用替代技术(游离皮瓣)。