Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT.
J Hand Surg Am. 2020 Dec;45(12):1123-1133. doi: 10.1016/j.jhsa.2020.05.010. Epub 2020 Jul 16.
Currently, numerous assessment tools are available to measure functional outcomes after bilateral hand transplantation. The purpose of this article is to present our experience utilizing quantitative assessment tools for functional evaluation and to describe our results after bilateral hand transplantation.
A single surgeon's experience with bilateral hand transplantation from 2011 to 2016 was retrospectively reviewed. Three bilateral hand transplantations were performed in 2 adults and 1 child. A minimum 2-year follow-up evaluation was available. For the adult patients, postoperative outcome measures included patient-reported pain and disability scores, return of sensation, muscle strength, range of motion, and return to work/activities of daily living, the Hand Transplant Scoring System (HTSS), the Sollerman hand function test, and complications. For our pediatric patient, postoperative outcome measures included the Functional Independence Measure for children (WeeFIM) scale, a functional independence measure for children, the 9-Hole Peg Test, the Box and Block test, and complications.
Our 2 adult patients were age 28 and our pediatric patient was age 8 at transplantation. Follow-up ranged from 2 to 7 years. The functional assessments were performed over a period from 11 to 48 months after transplantation. Both adult patients achieved functional independence and the HTSS, Short Form-36 Health Score (SF-36), DASH, and Sollerman tests demonstrated sequential improvement compared with pretransplantation scores assessed with the use of prostheses. Our pediatric patient demonstrated improvement in his Box and Block test score for each hand at sequential visits after transplantation. His 9-Hole Peg Test demonstrated improvement, and his WeeFIM assessment at 20 months indicated a greater level of independence.
Patient-reported outcomes and the Sollerman test when used in addition to the HTSS appear to reflect functional improvement in adult patients after bilateral hand transplantation. Although children pose a unique challenge with functional assessment, we found the WeeFIM assessment, 9-Hole Peg Test, and the Box and Block test helpful in evaluating functional outcomes in our pediatric patient.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
目前，有许多评估工具可用于测量双侧手部移植后的功能结果。本文旨在介绍我们使用定量评估工具进行功能评估的经验，并描述我们在双侧手部移植后的结果。
回顾性分析 2011 年至 2016 年期间，一位外科医生对双侧手部移植的经验。在 2 名成人和 1 名儿童中进行了 3 例双侧手部移植。所有成人患者均获得至少 2 年的随访评估。对于成人患者，术后评估指标包括患者报告的疼痛和残疾评分、感觉恢复、肌肉力量、活动范围和重返工作/日常生活活动能力、手部移植评分系统（HTSS）、Sollerman 手部功能测试以及并发症。对于我们的儿科患者，术后评估指标包括儿童功能独立性测量（WeeFIM）量表、儿童功能独立性测量、9 孔钉测试、箱式和块状测试以及并发症。
我们的 2 名成人患者年龄分别为 28 岁和 8 岁。随访时间为 2 至 7 年。功能评估是在移植后 11 至 48 个月进行的。两名成年患者均实现了功能独立性，HTSS、SF-36 健康评分量表、DASH 和 Sollerman 测试与使用假肢评估的术前评分相比均表现出逐步改善。我们的儿科患者在移植后每次就诊时，双手的箱式和块状测试评分都有所提高。他的 9 孔钉测试也有所改善，他的 20 个月 WeeFIM 评估显示他具有更高的独立性。
患者报告的结果和 Sollerman 测试除了 HTSS 之外，似乎反映了成人双侧手部移植后功能的改善。虽然儿童的功能评估具有独特的挑战，但我们发现 WeeFIM 评估、9 孔钉测试和箱式和块状测试有助于评估我们儿科患者的功能结果。
研究类型/证据水平：治疗性 V。
