墨西哥的双侧前臂移植：2年的结果

Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.

作者信息

Iglesias Martin, Butron Patricia, Moran-Romero Mario, Cruz-Reyes Angel, Alberu-Gomez Josefina, Leal-Villalpando Paulino, Bautista-Zamudio Jorge, Ramirez-Berumen Maria, Lara-Hinojosa Euridice, Espinosa-Cruz Veronica, Gaytan-Cervantes Rocio, Bravo-Ruiz Leonardo, Rodriguez-Rojas Elizabeth, Ramos-Peek Jaime, Garcia-Alvarez Miriam, Vega-Boada Felipe, Sierra-Madero Juan, Gamboa-Dominguez Armando, Gonzalez-Sanchez Judith, Contreras-Barbosa Sarai, Navarro-Lara Africa, Vazquez-Lamadrid Jorge, Guzman-Gonzalez Juan

机构信息

1 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico. 2 Secretaría de Salud del Distrito Federal, Mexico City, Mexico. 3 Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico. 4 Hospital Angeles Mocel, Mexico City, Mexico. 5 Physical Medicine and Rehabilitation, Mexico City, Mexico.

出版信息

Transplantation. 2016 Jan;100(1):233-8. doi: 10.1097/TP.0000000000000827.

DOI:10.1097/TP.0000000000000827

PMID:26154392

Abstract

BACKGROUND

Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire.

METHODS

We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012.

RESULTS

At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes.

CONCLUSIONS

Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.

摘要

背景

前臂近端和上臂移植患者已获得和/或维持了肘关节功能以及手部外在肌的全主动活动范围，但保护性感觉减退，手部内在肌功能不佳。根据手臂、肩部和手部功能障碍问卷评估，这些患者的功能有所改善。

方法

我们报告了一例52岁男性患者，因高压电烧伤需行上肢截肢。2012年5月，他在墨西哥城接受了双侧前臂近端移植手术。

结果

随访2年时，免疫抑制治疗未导致代谢、肿瘤或感染并发症。在移植物与受者界面出现了瘢痕疙瘩。发生了4次急性排斥反应：第四次采用甲泼尼龙、利妥昔单抗和免疫球蛋白治疗。未检测到慢性排斥反应。腕部和手指的外在肌功能良好。虽然内在肌在术后15个月显示有电活动，但临床上并无实际作用。2年后，手部功能足以让患者抓握轻质和中型物体。患者的手臂、肩部和手部功能障碍问卷评分从50.00分提高到30.83分，其手移植评分系统评分为良好，右/左为69/73（满分100）。患者及其家属对功能和美观效果非常满意。