离断肢体保存修复技术研究进展  

Progress of research on the technology of preservation and repair of severed limbs

作　　者：张熔基 史纪 赵建文 黎庆 张建政[2] 柴伟[2] 孙天胜 Zhang Rongji;Shi Ji;Zhao Jianwen;Li Qing;Zhang Jianzheng;Chai Wei;Sun Tiansheng(Hebei North University,Zhangjiakou 075000,China;Senior Department of Orthopedics,PLA General Hospital,Beijing 100853,China)

机构地区：[1]河北北方学院,张家口075000 [2]解放军总医院骨科医学部,北京100853

出　　处：《中华骨科杂志》2024年第22期1503-1508,共6页Chinese Journal of Orthopaedics

基　　金：军队装备科学研究项目(LB2022B020200);北京市自然科学项目(7232165);解放军总医院新技术项目(2023102)。

摘　　要：肢体保存技术是影响离断肢体再植或异体移植疗效的关键因素。静态冷保存技术仍然是目前离断肢体体外保存的金标准,这种方法操作简便,还能最大限度地降低氧和能量代谢,但维持肢体活力的时间窗较短,通常仅4~6 h,远远不能满足临床转运、伤情处置等医疗资源的衔接需求。为解决这一问题,研究人员开始探索通过向离断肢体提供氧气和营养物质的新方法,这催生了机械灌注技术和气体灌注技术。前者通过模拟生理状态来清除代谢废物并供给营养物质,延长保存时间和提高修复效果;后者则直接利用脉管系统将氧气输送到组织中,以保持组织完整性。尽管这些新兴技术具有潜力,但他们在实际应用中的时间限制和复杂性仍需进一步探索。另外,对不适宜立即再植的离断肢体,自体异位寄养技术和临时血管内分流为保存提供了新思路。前者通过构建临时寄养环境来维持组织活力;后者则在受损部位建立临时血管通路,输送供体血液以保持血流供应和促进修复。异种交叉循环技术结合了多个学科的最新进展,展示了显著的潜力,但目前还面临着伦理、免疫排斥和技术复杂等挑战。上述新技术为离断肢体的保存与修复带来了变革。我们对近年来静态冷保存、气体灌注、机械灌注保存及暂时性异位寄养保存技术在肢体保存方面的研究现状和发展进行梳理。Limb preservation techniques of severed limbs play an important role in autologous replantation or allografting.At present,static cold storage(SCS)remains the gold standard for the in vitro preservation of severed limbs,which minimizes oxygen and energy metabolism.However,with a relatively short time window of 4-6 hours,SCS is insufficient for clinical transfer,injury management and other medical resources.To address this issue,researchers have initiated investigations into alternative methods of supplying oxygen and nutrients to severed limbs,leading to the development of mechanical perfusion technology and per-sufflation technology.Mechanical perfusion technology aims to clear metabolic waste and provide essential nutrients by mimicking a physiological state,thereby prolonging the preservation time and improving the outcome of the repair.Per-sufflation technology aims to deliver oxygen directly to the tissue using a vascular system to maintain tissue integrity.With these emerging technologies showing great promise,further exploration and refinement are needed to address their time constraints and complexity in clinical work.Furthermore,for severed limbs that are not suitable for immediate reimplantation,autologous heterotopic parasitism techniques and temporary endovascular shunts offer promising avenues for preservation.Autologous heterotopic parasitism techniques maintain tissue viability by constructing a temporary parasitic environment,while temporary endovascular shunts establish a temporary vascular access at the damaged site to deliver donor blood,thereby maintaining blood flow and promoting repair.Xenogeneic cross-circulation techniques combine recent advances from multiple disciplines and demonstrate remarkable potential;however,they currently face challenges such as ethics,immune rejection,and technical complexity.The combination of these novel techniques has led to a significant advancement in the field of limb preservation and repair.This article aims to provide an overview of the current research s

关 键 词：肢体再植 肢体移植 静态冷保存 机械灌注 暂时性异位寄养 

分 类 号：R687.5[医药卫生—骨科学]