CAJ | 학술논문

目的报告2例异体移植手早期功能康复结果。方法2例心理和一般情况良好的右手外伤性缺如患者，通过组织配型后接受2例与其相匹配、无传染病脑死亡供者的异体手，移植方法基本同断肢再植。术后密切观察生命体征、移植手血液循环和监测免疫排斥反应。术后进行心理治疗并在康复医师指导下进行功能锻炼。结果Tinel征检查显示神经生长速度较快。术后4个月，移植手可以持物，痛、温觉测试和Tinel征检查显示，神经已生长至拇指、示指和小指末节及中指、环指远侧指间关节。术后5个月，例1移植手拇指、小指有外展动作。术后6个月，例1拇指、小指外展动作增强且可抗阻力，能写字；例2移植手拇指、小指亦有外展动作。术后7个月，两患者尺、桡骨愈合良好，去除内固定物并同时行肌腱和神经松解。术后8个月，移植手功能进一步加强，可以打羽毛球、拍篮球。术后9个月可以切菜。术后10个月，例1手指运动功能恢复等级为良，正中神经优、尺神经良；例2手指运动功能恢复等级为良，正中神经与尺神经均为可。结论移植手近期功能与自体断肢再植相似。为了提高异体移植手的功能，术前应严格筛选病例，受、供体组织配型要匹配，并制定合理的手术方案；术中操作精确、熟练；术后合理应用免疫抑制剂，同时配合实施良好的康复措施，对促进异体移植手的功能康复具有重要意义。
목적보고2례이체이식수조기공능강복결과。방법2례심리화일반정황량호적우수외상성결여환자，통과조직배형후접수2례여기상필배、무전염병뇌사망공자적이체수，이식방법기본동단지재식。술후밀절관찰생명체정、이식수혈액순배화감측면역배척반응。술후진행심리치료병재강복의사지도하진행공능단련。결과Tinel정검사현시신경생장속도교쾌。술후4개월，이식수가이지물，통、온각측시화Tinel정검사현시，신경이생장지무지、시지화소지말절급중지、배지원측지간관절。술후5개월，례1이식수무지、소지유외전동작。술후6개월，례1무지、소지외전동작증강차가항조력，능사자；례2이식수무지、소지역유외전동작。술후7개월，량환자척、뇨골유합량호，거제내고정물병동시행기건화신경송해。술후8개월，이식수공능진일보가강，가이타우모구、박람구。술후9개월가이절채。술후10개월，례1수지운동공능회복등급위량，정중신경우、척신경량；례2수지운동공능회복등급위량，정중신경여척신경균위가。결론이식수근기공능여자체단지재식상사。위료제고이체이식수적공능，술전응엄격사선병례，수、공체조직배형요필배，병제정합리적수술방안；술중조작정학、숙련；술후합리응용면역억제제，동시배합실시량호적강복조시，대촉진이체이식수적공능강복구유중요의의。
Objective To report the results of funtional recovery of hand in two patients undergone human hand allograft. Methods Two male recipients, with traumatic right wrist amputation for 2 years, were matched respectively with two donors died of cerebral injury. The transplantation procedure was similar to that of autologous replantation of severed limb. After surgery the patients were given wide spectrum antibiotics, anticoagulations, antispasm agents, and immunosuppressants. Clinical observations included vital signs and circulation of the hands. Immune status was monitored and skin biopsy was done to exclude rejection. The patients were also given psychotherapy and hand rehabilitation. Results Rapid regeneration of the nerves were determined by Tinel s sign. At 4 months after surgery the function of grafted hands recovered well, which could already hold a drinking cup. The nerves had grown to the end of fingers and electromyograph showed regenerative action potentials of thenar muscles. At 5 months the thumb and small finger could abduct in case 1. At 6 months the thumb and small finger could abduct against resistance in case 1, and the thumb and small finger could also abduct in case 2. At 7 months the bone united and the fixation were removed, meanwhile the tendons and nerves were released. At 8 months the hand function get further improved. At 10 months the two grafted hands were graded good by total active motion evaluation, and in case 1 the median and ulnar nerves recovered excellently and well respectively; and in case 2 both of the median and ulnar nerves recovered fairly. Conclusion The early function recovery was similar to that seen in autologous replantation. In order to have good function of transplanted hand proper, patients should be carefully chosen. Important key of success are: ideal histocompatability, the use of immunosuppressants and thorough planning of atraumatic operative procedure, as well as the implementing of rehabilitation.