从异体手移植看手康复之发展.pptx

从异体手移植看手康复之发展Introduction异体手移植是世界外科界的临床难题，它不同于目前成熟的器官（如肾等） 移植，其组织主要来源外胚层，皮肤、肌肉等软组织对其具有强烈的排斥反应。1998年9月，法国进行了全球第一例异体手移植。1999年1月，美国进行了国际上第二例异体手移植手术。1999年9月21日广州第一军医大学南方医院创伤骨科裴国献教授、顾立强、朱立军博士等人成功完成了2例异体手移植手术。全世界手部异体移植之统计台湾于2014完成首例异体手移植截至目前已有3例，其中2例单侧，1例双侧手部移植医疗团队医疗团队：手外科骨科检验科X光科精神科康复科新陈代谢科药剂科社工护理4 Phases of RehabilitationPhase 1Phase 2Phase 3Phase 4Pre-operative （術前）Initial post-operative (weeks 0-4)（術後早期）Intermediate (weeks 4–8)（中期）Late (from 8 weeks forward)（後期）Phase 1Pre-operative Phasecollect information :such as medical history, injury history, previous treatment(s), and occupation. analysis and assessments :stump size, shape, length, sensitivity and baseline pain, ROM, strength, sensory status of both upper extremities from shoulders to digits, functional analyses, and ability to perform ADLs. evaluate the patient/familys ability to understand, cope with and follow through with treatmentdevelop reasonable functional goals plan of care. Rehabilitation ProtocolPhase 2 Initial Phase (Days 0 to 14) TimingImmediately after HA, all therapy takes place in the in-patient setting.Therapy takes place daily, with sessions spread throughout the day and active participation by rehabilitation professionals, nursing staff, and the hand transplant recipients family.Rehabilitation programPositioningThe transplanted hand(s) are positioned to avoid vascular compromise and edema, protect the repairs, and ensure optimum length–tension relationships between extensor and flexor tendons. Edema is managed through positioning and later through compression.SplintingUse a volar resting splint fabricated preoperatively, to keep the hand in a resting position while preventing joint contractures.Dynamic crane extension outrigger splint is fabricated as soon as possible after surgery, and the hand transplant recipient wears it continuously during the day.Rehabilitation programExercisePassive ROM exercises within the first 1–3 days post-operative, and evaluate perfusion on every digit before tre