摘要
目的 探讨异体手移植的手术设计与技术操作要点。方法 2例右手缺失病人行异体手移植,参照自体断腕再植的基本程序,依次受区准备、供手准备、移植手组织重建。骨骼再接平面位于桡尺骨离桡骨关节面2.5cm～3cm处,桡骨阶梯状截骨、螺钉固定,尺骨平面截骨、三棱针或钢板内固定;先缝合屈侧深肌腱,吻合尺、桡动脉后静脉放血,再吻合头、贵要静脉,缝合屈侧浅肌腱及伸侧肌腱,吻合神经,缝合皮肤。术后抗免疫排斥、抗感染、抗凝、抗血管痉挛。结果 手术时间分别为7h52min、9h10min,供手缺血时间6h、ah 19min。病例一移植手血循环良好;病例二术后3小时静脉危象,经手术恢复血循环。现术后8个月移植手存活良好,无免疫排斥反应发生,手握持功能及手部感觉已恢复,手内在肌功能部分恢复。结论 异体手移植的手术设计重点依据手缺失残端位置确定受一供体手移植平面,组织重建的顺序为骨骼、深肌腱、动脉、静脉、浅肌腱、神经和皮肤。
Objective To explore the operative design and technique of human hand allotransplantation. Methods Two cases with the right hand defect were treated with hand allotransplantation. Refered to the elementary procedure of autologous wrist replantation, the dissection of the recipient' s stumps and the donor hands, hand allo-graft, and their tissue reconstruction were carried out by turns. The levels of the skeletal reconnection were located at 2. 5cm - 3cm above the articular surface of radius, where radius was dealt with the ladder - like osteotomy and fixed with screws, and ulnar was dealt with the plane osteotomy and fixed with trifin needle or plate. After suture of the profundus flexor tendons and anastomosis of the ulnar and radial arteries, blood was drawn from veins. Then the cephalic and basilic veins, the superficial flexor tendons, the extensor tendons, nerves were anastomosed, and skin was closed at last. Postoperatively, some measures were adopted to prevent the immunological rejection, infection, blood coagulation and vessel spasm. Results The operations lasted 7h 52min and 9h 10min, and ischaemic time of the transplanted hands were 6h and 6h 19min, respectively. The blood circulation of one case was fine. Vein crisis occurred in another case at the third hour after operation, which was eliminated by exploration. The transplanted hands have survived well without immunological rejection for 12 months. The prehension and the sense of the hands had restored, and the function of the hand intrinsic muscles had partially restored. Conclusion It was emphasized to determine the transplant level in accordance with the stumps of the patient's hands in the operative design of hand allotransplantation. The sequences for the tissue reconstruction were skeleton, profundus tendon, artery, vein, superficial tendon, nerve and skin.
