Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, and the Neural Engineering Center for Artificial Limbs, Rehabilitation Institute of Chicago.
Plast Reconstr Surg. 2012 Jan;129(1):187-194. doi: 10.1097/PRS.0b013e3182268d0d.
Lower limb amputation is a common and growing problem in the United States. Current prosthetic technology is insufficient for transfemoral amputees to safely control their prostheses for demanding exercise such as stair climbing. Using a technique called targeted reinnervation, intuitive control of prosthetic devices has been achieved for upper limb amputees. To bring this technique to transfemoral amputees, a comprehensive understanding of the location of motor and sensory nerves is required.
Five lower limbs were dissected and the locations of motor points for 13 muscles of the thigh were documented, as was the location of the posterior femoral cutaneous nerve of the thigh. A transfemoral amputation was performed on one limb to demonstrate the targeted reinnervation procedure. The tibial and common peroneal divisions of the sciatic nerve were coapted to the motor points of the semimembranosus and biceps femoris, respectively. The posterior femoral cutaneous nerve was coapted in end-to-side fashion to the tibial nerve.
The average number of motor points per muscle were as follows: sartorius, 4.75; rectus femoris, 3.25; vastus lateralis, 4.5; vastus intermedius, 4.5; vastus medialis, 4; adductor brevis, 2.3; adductor longus, 3; adductor magnus, 2.7; gracilis, 3; semitendinosus, 1.5; semimembranosus, 2.5; biceps femoris long head, 2.75; and biceps femoris short head, 1.
The results of this study indicate that targeted reinnervation is technically feasible in a transfemoral amputee.
下肢截肢在美国是一个常见且不断增长的问题。目前的假肢技术还不足以让股骨截肢者安全地控制他们的假肢，使其能够进行爬楼梯等高要求的运动。通过一种称为靶向神经再支配的技术，已经实现了上肢截肢者对假肢的直观控制。为了将这项技术应用于股骨截肢者，需要全面了解运动和感觉神经的位置。
解剖了 5 条下肢，记录了大腿 13 块肌肉的运动点位置，以及股后皮神经在大腿的位置。在一条下肢上进行了股骨截肢，以演示靶向神经再支配的过程。坐骨神经的胫神经和腓总神经分支分别与半膜肌和股二头肌的运动点吻合。股后皮神经以端侧吻合的方式与胫神经吻合。
平均每个肌肉的运动点数量如下：缝匠肌，4.75；股直肌，3.25；股外侧肌，4.5；股中间肌，4.5；股内侧肌，4；短收肌，2.3；长收肌，3；大收肌，2.7；股薄肌，3；半腱肌，1.5；半膜肌，2.5；股二头肌长头，2.75；和股二头肌短头，1.75。
本研究结果表明，靶向神经再支配在股骨截肢者中具有技术可行性。
