异体双手移植后的神经再生问题:1例探讨

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.

Neural regeneration in allografted human two hands :one case analysis

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.