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移植:新手上感覺的恢復

【?2008-10-14 發布?】 美迪醫訊
美迪網領先的醫療器械電子商務平臺


在移植手術后四個月一位35年前經歷過手切除手術的54歲的男性,在移植手術后大腦中原先“手掌區域”又顯示出觸摸的感覺
這個發現主要集中在這個男人右側移植的附帶主要神經,骨骼、筋腱、和肌肉的手掌上。“這還需要確認”這個研究的負責人Scott H. Frey談到:“大腦中關于每根手指的感覺將會慢慢增加。在手術后四個月,基本的觸摸感覺就被報告出現在手掌底部的拇指下方的肌肉和拇指側面靠近橈神經的區域。”
磁共振技術被用于記錄當感官刺激被傳達到手和面對移植接受體時大腦的活動。結果顯示感覺信號的傳導從移植的手上傳遞到截肢手術之前大腦接受手部感覺信號的區域。
從大腦的角度來說這個個體是非常獨特的。Frey談到“我們知道當一個人失去了他的手,大腦接收手部感覺信號的區域會重新組織已取代原來的感覺傳導方式。現在,甚至在截肢35年之后,這個感覺傳入的恢復看起來可以找回原來手部感覺,這種大腦接受這些改變的能力完全是因為在接受截肢手術時他的大腦已經完全發育成熟”
重新組織感覺區域開始在失去肢體一小時后開始。研究顯示神經元開始從新的肢體上接受感覺信號。“在那里發生了什么還不完全清楚,也不清楚這個改變會持續多長時間”,Frey說:“但是一種思路是。于這個情況沒有大腦的會讓這種空白的狀態停留很長。”之后這個受傷的男人報告稱幻覺逐漸的減少并且疼痛的報告經常出現在接受移植的患者中。
Frey還談到“什么是手的移植在歷史上第一次允許我們在去問的問題是:在從新組織建立之后是否可能去保留這個感覺的恢復到大腦?這個回答看起來會是“是”答案將隨著在移植手術之案例增多而更加確定。”

Transplantation: Signs of Sensory Recovery in New Hand
Four months after a hand transplant - 35 years after amputation - a 54-year-old man’s emerging sense of touch is registered in the former "hand area" of his brain, says a neuroscientist. 10/10/2008
The finding centres only on the man's right palm of a donated hand, which was attached along with major nerves, bones, tendons, and muscle. Still to be determined, lead author Scott H. Frey said, is how the brain’s map of the individual fingers will evolve with increasing sensation. Just four months post-surgery, initial touch sensations were reported on the thenar eminence - muscle on the palm just below the thumb - and on the lateral base of the thumb near the radial nerve.
Functional magnetic resonance imaging was used to record brain activity while sensory stimuli were delivered to the hands and faces of the transplant recipient and four control participants. Results showed that sensory signals from the transplanted hand are being processed in the same brain regions that would have formerly handled sensations from the hand prior to amputation.
"This individual is very unique from a brain standpoint," Frey said. "We know that when someone loses a hand, there are reorganisational changes that take place in areas of the brain that have received sensory input from that hand. Yet, even after 35 years, the restoration of sensory input seems capable of recapturing the former territory of the hand. The capacity of the brain to reverse these changes is all the more striking in light of the fact that his brain was fully mature when the amputation occurred.”
Reorganisation in sensory regions begins within hours of a limb loss. Research has shown that neurons that had been devoted to receiving sensory inputs from the limb take on new duties. Exactly what happens is not entirely clear, nor is it certain how long such changes continue, Frey said, "but one way to think about it is that none of the brain's real estate is left vacant for very long". Over time, the injured man reported gradual reductions of phantom sensations and pain often reported by amputees.
"What this hand transplant allows us to ask for the very first time in history is: Following reorganisational changes, is it possible to reverse the restoration of sensory input into the brain? The answer, which appears to be yes, extends well beyond the case of hand transplants," Frey said.

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