Carlsen Brian T, Prigge Pat, Peterson Jennifer
Mayo Clinic, Division of Hand Surgery, Rochester, MN, USA; Mayo Clinic, Division of Plastic Surgery, Rochester, MN, USA.
Advanced Arm Dynamics, North Central Center of Excellence, Maple Grove, MN, USA.
J Hand Ther. 2014 Apr-Jun;27(2):106-13; quiz 114. doi: 10.1016/j.jht.2013.10.007. Epub 2013 Dec 3.
For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications.
几十年来，假肢的使用一直是上肢截肢后恢复功能的唯一选择。近年来，假肢领域取得了进展。这些进展包括假肢设计与功能、特定活动装置、美学改善以及辅助手术程序，以改善外形和功能。靶向性神经再支配是一项令人兴奋的进展，它使近端截肢后使用假肢的功能更加灵活和直观。另一项在几乎所有医学领域都极具前景的显著进展是复合组织移植，如手部和面部移植。手部移植有望成为能提供外形、功能和感觉的终极修复手术。然而，就康复和毒性免疫抑制而言，该手术仍需付出巨大代价，应仅限于假肢重建失败的精心挑选的患者。手部移植和假肢重建不应被视为相互竞争的选择。相反，它们是两种具有不同风险/收益概况、不同适应症且因此具有截然不同意义的治疗选择。
