Timeline of Functional Recovery Following Hand and Upper-Extremity Transplantation

IF 2.4 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2026-09-01 Epub Date: 2026-06-06 DOI:10.1016/j.jhsa.2026.05.003

Isaac Mordukhovich BA, Connor Roncagli BS, Natalie Hoffner BS, Kyle Barclay BA, Antonio Rampazzo MD, PhD, Bahar Bassiri Gharb MD, PhD

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Abstract

Purpose

The degree to which motor and psychosocial functions may recover following hand and upper-extremity transplantation (HUET) remains unclear. This study quantifies HUET outcome changes in the first 10 years post-transplantation to provide insight into this question.

Methods

A systematic review of PubMed, Embase, Cochrane, and Medline yielded 2104 records; 118 articles were included in the final review. HUETs above the proximal third of the forearm were designated as proximal and the remaining distal. Semmes-Weinstein Monofilament (SWMF) test, grip strength, Kapandji, finger and thumb total active range of motions (TAROMs), Carroll, Short Form 36 (SF-36), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Hand Transplantation Score System (HTSS) were recorded according to patient and postoperative year (POY).

Results

Ninety-seven patients were identified between 1998 and 2025. Distal HUETs’ SWMF improved from POY1 (4 [4−4]) to POY2 (5 [4−6]). Power grip remained constant for distal and proximal HUETs, but proximal HUETs recovered less than distal HUETs (4.51 ± 1.49 kg vs 7.33 ± 0.71 kg). Lateral pinch strengths did not differ between groups. Proximal HUETs’ lateral grips demonstrated sustained improvement after POY3. Bilateral HUETs demonstrated higher SF-36 scores than unilateral HUETs across POY1−10. HTSS measured significant improvements in distal HUETs increasing from 65 (57−79.5) (POY1) to 76 (71−85) by POY3, while proximal HUET only improved from POY1 (61 [45−70.5]) at POY8−10 (82.5 [72−91.5]). Finger TAROMs remained largely unchanged after POY1 while distal and proximal Kapandji thumb opposition scores improved at POY3−6 and POY8−10, respectively.

Conclusions

Transplant level influenced recovery of power grip and HTSS. HUET power grip strength and finger TAROM stabilized after POY1 while lateral grip, Kapandji scores, HTSS, and SWMF showed improvements in the decade following transplantation, mostly for distal HUETs. Bilateral HUETs had better psychosocial (SF-36) outcomes than unilateral HUETs, but no difference in DASH scores.

Type of study/level of evidence

Therapeutic IV.

查看原文本刊更多论文

手部和上肢移植术后功能恢复时间表。

目的：手部和上肢移植（HUET）术后运动和社会心理功能恢复的程度尚不清楚。本研究量化了移植后前10年HUET结果的变化，以深入了解这一问题。方法：对PubMed、Embase、Cochrane和Medline进行系统综述，共获得2104条记录；最终审评纳入118篇文章。前臂近三分之一以上的huet被指定为近端，其余的被指定为远端。根据患者和术后年份（POY）记录semms - weinstein单丝（SWMF）测试、握力、Kapandji、手指和拇指总活动范围（TAROMs）、Carroll短表36 （SF-36）、手臂、肩部和手部残疾问卷（DASH）和手移植评分系统（HTSS）。结果：1998年至2025年共发现97例患者。远端HUETs的SWMF从POY1（4[4-4]）改善到POY2（5[4-6]）。远端和近端HUETs的握力保持不变，但近端HUETs恢复的力度小于远端HUETs（4.51±1.49 kg vs 7.33±0.71 kg）。各组间侧捏强度无显著差异。近端HUETs的侧握表现出POY3后的持续改善。在POY1-10中，双侧huet的SF-36评分高于单侧huet。HTSS测量了POY3对远端HUET的显著改善，从65 (57-79.5)（POY1）增加到76(71-85)，而近端HUET仅在POY8-10（82.5[72-91.5]）时从POY1（61[45-70.5]）改善。POY1后，手指TAROMs基本保持不变，而远端和近端Kapandji拇指对立评分分别在POY3-6和POY8-10时提高。结论：移植水平影响握力和HTSS的恢复。POY1后HUET用力握力和手指TAROM稳定，而侧握力、Kapandji评分、HTSS和SWMF在移植后的十年中有所改善，主要是远端HUET。双侧HUETs比单侧HUETs具有更好的社会心理（SF-36）结果，但DASH评分无差异。研究类型/证据水平：治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.