Singh Mansher, Sisk Geoffroy, Carty Matthew, Sampson Christian, Blazar Philip, Dyer George, Earp Brandon, Pribaz Julian, Pomahac Bohdan, Talbot Simon G
Boston, Mass. From the Division of Plastic Surgery and the Department of Orthopedic Surgery, Brigham and Women's Hospital.
Plast Reconstr Surg. 2016 Jan;137(1):185-189. doi: 10.1097/PRS.0000000000001872.
Since the first successful hand transplantation in 1998, 72 patients have been operated on for unilateral/bilateral hand transplantation across 13 countries. There have been multiple studies evaluating the outcomes of hand transplantation; however, there is considerable variability among the outcome measures evaluated in these studies.
This article reports functional outcomes in a patient with bilateral hand transplants at a mid-forearm level with serial follow-ups over 3.5 years. Different parameters used to study the functional outcomes include the Disabilities of the Arm, Shoulder, and Hand score, the Carroll test, the Hand Transplant Score System, the Short Form-36 Health Survey, and routine occupational therapy measures. Various task-oriented outcomes were also assigned to provide milestones to the recovery.
The patient had a Disabilities of the Arm, Shoulder, and Hand score of 40, a Carroll test score of 48 (right) and 49 (left), and a Hand Transplant Score System score of 58 (right) and 57.5 (left) at 3.5-year follow-up. Interestingly, his objective scores did not change significantly during the follow-up, but he continued to function quite independently and is subjectively pleased with his outcomes.
Multiple functional outcome measures provide an objective way to follow patients who have undergone hand transplantation. The authors propose a series of measures to elucidate subtleties in functional gains. However, use of this series in isolation may belie subjectively good results. They also propose a series of milestones in the recovery to give a better real-world explanation of progress.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
自1998年首次成功进行手部移植以来，13个国家的72例患者接受了单侧/双侧手部移植手术。已有多项研究评估手部移植的结果；然而，这些研究中评估的结果指标存在相当大的差异。
本文报告了一名前臂中段水平双侧手部移植患者的功能结果，并进行了3.5年的连续随访。用于研究功能结果的不同参数包括手臂、肩部和手部残疾评分、卡罗尔测试、手部移植评分系统、简短健康调查问卷36项以及常规职业治疗措施。还分配了各种以任务为导向的结果，为恢复过程提供里程碑。
在3.5年的随访中，该患者的手臂、肩部和手部残疾评分为40分，卡罗尔测试评分为48分（右侧）和49分（左侧），手部移植评分系统评分为58分（右侧）和57.5分（左侧）。有趣的是，他的客观评分在随访期间没有显著变化，但他继续保持相当独立的功能，并且对自己的结果主观上感到满意。
多种功能结果测量方法为跟踪手部移植患者提供了一种客观的方式。作者提出了一系列措施来阐明功能改善中的细微差别。然而，单独使用这一系列措施可能会掩盖主观上良好的结果。他们还提出了一系列恢复过程中的里程碑，以便更好地从现实角度解释进展情况。
临床问题/证据水平：治疗性，V级
