手缺损的重建

手是人类创造文明的重要器官,手缺损的重建一直是临床医学的一大难题。美容假手仅有装饰用途,工具手、Kruckenberg前臂分叉成形术因作用有限,现已少用。肌电假手为义肢市场主流产品,但其动作准确性有待提高;显微外科再造手有感觉功能,可代偿部分手功能,但外形欠佳。前臂残端移植一个足趾即再造手指控制的电子假手,使动作准确度提高,是现阶段一项较为理想、值得推广应用的新技术。近年来开展的同种异体手移植已成功报道10余例,由于免疫排斥反应需长期服用免疫抑制剂,尚不宜作为常规手术推广,但一旦有效解决移植免疫问题,相信异体手移植将是手缺损重建的最佳方法。

Reconstruction of hand defects

Hands are an important organ with which mankind has created his civilizations. Functional reconstruction of hand defects is a difficult clinical problem. The cosmetic artificial hand has no other function than that of decoration. The tool hand and kruckenberg forearm furcate phalangisation have scarcely been utilized now because they have limited functions. The myoelectric artificial hand is the major product on the prosthese market, but its accuracy needs improving. Microsurgery can restore part of the sensory functions of the hand but can not restore its normal contour. Treatment of the lost part of the forearm with an electronic artificial hand, which is controlled by a reconstructed digit transplanted from the second toe to the forearm stump, improves the action accuracy. Wide application of this new technique is recommendable. More than 10 cases treated with allograft hand transplantation have been reported recently. Since these patients have to receive a long term therapy of immunosuppressive agents due to the immunological rejection,this method is not suitable to be a routine clinical operation. If the problems concerning transplantation immunity are solved, allograft hand transplantation will be an optimal method of functional reconstruction of hand defects.