【作者】 张信英； 于钟毓； 贾继峰；

【Author】 Zhang Xin Ying Yu Zhong Yu Jia Ji Feng et al

【机构】 哈尔滨医科大学附属第一医院骨科；

【摘要】 2001年1月23日,在多科室的协助下,完成一例异体双手移植术,现患者双手存活良好,已经渡过超急排斥反应期和加速排斥反应期,正在康复治疗中.患者男性18岁,一年前双下肢被炎车压掉,同时双手冻伤于腕上截肢.供体取自脑死亡自愿损献者.术前配型:ABO血型均为B型,Rh相符,群体反应性抗体(PRA)为阴性,人白细胞抗原(HLA)有三个位点相符,淋巴毒性交叉试验为阴性.手术在全麻下分4个小组同时进行,1组切取供体左手,2组切除供体右手,3组处理受体左手,4组处理受体右手.按术前计划进行切开暴露标记各种组织,供体在肱动脉处用4度UW器官保存液1000ml灌注,至流出液清澈为止.上述各组处理完毕后,两左手组和两右手组合并为左手组和右手组进行移植,每只手均吻合2条动脉,4条静脉,其他组织均进行了相应的修复,挠骨做成梯形截骨面,用两枚螺钉固定,尺骨用4孔钢板固定,双手移植平面在腕上5cm处.供体双手热缺血时间为65min,冷缺血时间为左手4h,右手4.17小时,手术历时10.33h.术后手术石膏外固定.术后常规应用抗生素,抗凝剂,解痉药物和联合应用抗免疫排斥反应药.用药量根据血液药物浓度调整.严密观察手部血循环和排斥反应现象的发生.患者术后第二天即开始做轻微的指间关节、掌指关节的被动活动,4周后开始做主动的锻炼,6周去除石膏外固定开始功能锻炼.患者术后经过顺利,术后8周时,接骨部位已有少量骨痂形成,术后3个月时,挠骨和尺骨均已骨性愈合;术后5个月手部的感觉已全部恢复,两点辨别觉为5cm,双手旋前旋回功能基本恢复正常,伸腕和屈腕功能接近正常,双手可持物喝水,使用遥控器和打电话.远期功能恢复待进一步观察和治疗.更多还原

【Abstract】 A double hand allograft had been performed on January 23 2001 supported by other departments. Now the double hand had survived hyperacute rejection and accelerated rejection. Physiotherapy has being done.The recipient male 18 years old. the double lower limbs were amputated in a traffic accident. At the same time the double hand were amputated due to freezing. The donor was a brain- dead man volunting to give out his hands. The donor had the same blood group(B and Rh+ )with the recipient. There are six HLA match. The crossed lymph toxic test is negtive.Under the general anaesthesia, the recipient and the donor were operated at the same time with four teams. The first team is to harvest donor’ s left hand, the second team to harvest donor’s right hand, the third team to deal with the recipient’s left hand and the fourth team to deal with the recipient’s right hand. According to preoperation plan, The anatomical structures to be microusurgically joined were sequentially dissected and tagged from palmar to dorsal. The recipient’s limb was irrigated with 1000 mL of UW organ preservation solution(4C ) until the clear liquid run out from the trim of the skin. Once all structures were ready, the graft was transferred to the main operating table. Osteosynthesis was done with four - hole plates on ulnar and two srews on ladder - shaped radius. The level of the transplantated hands is 5 cm proximal to the wrists. Hot ischaemic time is 65min. cold ischaemic time is 4hours on left hand and 4.17 hours on right hand. The whold operation was accomplished 10. 33 hours later. A plaster volar splint was used to fix wrists.Antibiotics anticoagulant and immunosuppressant were used routinely. The circulation and the rejection were under the supervision.Physiotherapy was started 16 h after surgery. Controlled - motion passive exercises was done on metacarpophalangeal and interphalangeal. Active exercises began 4 weeks later. The plastic splint was removed 6 weeks after operation.The progress is satisfactory. At 8 weeks there are a little callus, at Smonth ulnar and radius was healing. At Smonth the sensation returned. Supination and pronation recovered. The flexion and extension of wrist returned. The patient can hold a cup to drink or can pick up a telephone or can use controlle of TV.更多还原