OBJECTIVE: To study the morphological character of long head of triceps muscle for clinical application in reconstruction of shoulder abduction. METHODS: Forty-four upper extremities of fixed human adult cadavers were carefully dissected. The origins and the pedicles of blood vessels and nerves of long head of triceps muscle, as well as the maximum available size of the muscles, were measured. Six cases of clinical application of long head of triceps muscle for reconstruction of shoulder abduction were followed up for 3 to 11 months. RESULTS: The origins in the dorsal side of long head of triceps muscle were muscular and the ventral side were tendinous, which was 7.6 to 13.3 cm in length and 1.6 to 3.4 cm in width. The distance from the origin to the neurovascular pedicle was 5.7 to 11.4 cm. The radial nerve, which innervated the muscles, could be dissected for 2.9 to 11.8 cm in length. The blood supplies to the triceps muscle were from humeral artery (43.2%), 1.0 to 6.0 cm in length and 1.6 to 2.4 mm in diameter, and from humeral profundus artery (45.5%), 1.5 to 4.4 cm in length and 0.9 to 2.4 mm in diameter, if the vessel was separated to the humeral artery, the length was 1.5 to 6.3 cm. The neurovascular pedicles were multiple branched. In the 6 cases of clinical application of the triceps muscles, the operated shoulder could abduct from 5 degrees preoperatively (0 degree to 10 degrees) to 77.3 degrees (50 degrees to 90 degrees) postoperatively. CONCLUSION: In accordance to the anatomical character of the triceps muscles, the long head of triceps muscle is a suitable choice for reconstruction of shoulder abduction with optimistic outcomes.
目的 總結 14 例原位心臟移植的治療經驗。 方法 回顧性分析 2006 年 1 月至 2015 年 9 月我院行原位心臟移植術終末期心臟病患者的臨床資料，其中男 11 例、女 3 例，年齡 22～62（46.7±10.1）歲。4 例使用抗 Tac 單克隆抗體誘導治療，10 例使用巴利昔單克隆抗體誘導治療。采用 4℃ 組氨酸-色氨酸-酮戊二酸（HTK）液保護供心。2 例采用經典式原位心臟移植，12 例采用雙腔靜脈法行心臟移植。術后采用環孢素或他克莫司+嗎替麥考酚酯+激素三聯抗排斥方案。 結果 術后早期 1 例因多器官功能衰竭合并嚴重感染死亡。早期并發癥有：敗血癥 1 例，硬膜外血腫 1 例，急性腎功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要體外膜肺氧合支持 1 例。術后長期隨訪：截至 2016 年 6 月，2 例失訪，1 例于術后 30 個月因自行停服抗排斥藥物死于急性排斥，1 例于術后 36 個月死于肺癌。余 9 例存活 9～121 個月，生活質量良好。 結論 心臟移植是治療終末期心臟病的有效方法，熟練的手術技巧、合理的免疫抑制治療，圍術期管理經驗、密切監測和治療感染和排斥及患者依從性均影響著心臟移植的效果。