CAJ | 학술논문

背景:同种异体双手移植世界上开展不多,该病例为世界第4例异体双手移植.目的:探讨异体手移植免疫抑制状态下的神经再生特点.设计:病例分析.地点和对象:手术在哈尔滨医科大学附属第一医院完成.2001-01收治的1例双手腕上4 cm截肢患者,男,18岁.干预:1例双手缺失患者行异体手移植,手术过程基本同自体断腕再植,术中吻合正中神经、尺神经、尺神经腕背支和桡神经浅支.术后联合应用普乐可复(FK506)等免疫抑制剂抗免疫排斥反应.主要观察指标:通过Tinnel征观察神经恢复情况.结果:术后患者移植手存活良好,无免疫排斥反应发生.术后1个月Tinnel征示神经生长＞50 mm,2个月＞100 mm,3个月达200 mm左右,神经再生速度均＞2 mm/d.4个月痛、温觉、触觉拇指已恢复至指腹,其他4指至近指间关节水平,手主动运动可抓持物品、纸张;与Tinel氏征检查相符.结论:异体手移植免疫抑制状态下神经再生迅速,在较短时间内恢复手部感觉与手内在肌神经再支配,快于同平面的自体断肢再植,值得进一步探讨.
배경:동충이체쌍수이식세계상개전불다,해병례위세계제4례이체쌍수이식.목적:탐토이체수이식면역억제상태하적신경재생특점.설계:병례분석.지점화대상:수술재합이빈의과대학부속제일의원완성.2001-01수치적1례쌍수완상4 cm절지환자,남,18세.간예:1례쌍수결실환자행이체수이식,수술과정기본동자체단완재식,술중문합정중신경、척신경、척신경완배지화뇨신경천지.술후연합응용보악가복(FK506)등면역억제제항면역배척반응.주요관찰지표:통과Tinnel정관찰신경회복정황.결과:술후환자이식수존활량호,무면역배척반응발생.술후1개월Tinnel정시신경생장＞50 mm,2개월＞100 mm,3개월체200 mm좌우,신경재생속도균＞2 mm/d.4개월통、온각、촉각무지이회복지지복,기타4지지근지간관절수평,수주동운동가조지물품、지장;여Tinel씨정검사상부.결론:이체수이식면역억제상태하신경재생신속,재교단시간내회복수부감각여수내재기신경재지배,쾌우동평면적자체단지재식,치득진일보탐토.
BACKGROUND: Cases of human hand allograft have been scarcely reported in the world, and the present case is the fourth in the world.OBJECTIVE: To explore nerve regeneration under immunosuppression in human hand allotransplantation.DESIGN: Case analysis.SETTING and PARTICIPANTS: The operation was performed in the First Affiliated Hospital of Harbin Medical University. A man aged 18 years old amputated 4cm above the carpus with two hands was admitted in January 2001.INTERVENTION: One case of two-hand allotransplantation was performed in one recipient with loss of two hands. The operation process was similar to the replantation of severed hand at wrist level. Transplantation involved sutures of median nerve, ulnar nerve and its dorsal cutaneous branch, and superficial branch of radial nerve. Combined immunosuppressive therapy including tacrolimus(progrnf, FK506) was used to suppress rejection.MAIN OUTCOME MEASURES: Neural regeneration, as assessed by the presence of Tinnel's signRESULTS: Transplanted hands survived well without immunorejection.Tinnel's sign showed that the nerve regenerates more than 50 mm in 1month, more than 100 mm in 2 months, and about 200 mm in 3 months after the operation, namely more than 2 mm per day. The sense of pain and temperature recovered to distal segment of thumb and proximal segment of the little fingers in 4 months. Hands were able to move actively to catch goods and paper, which accorded to the Tinnel's test.CONCLUSION: Neural regeneration is faster in hand allotransplantation under immunosuppression. The sense of hand can recover and intrinsic muscles are reinerverated in a short term, faster than those in autogenous limb replantation at the same level. It deserves further studies.