Keith M W, Peckham P H, Thrope G B, Buckett J R, Stroh K C, Menger V
Department of Orthopaedic Surgery, Case-Western Reserve University, Cleveland, Ohio.
Clin Orthop Relat Res. 1988 Aug(233):25-33.
Functional neuromuscular stimulation (FNS) of the C5 and C6 tetraplegic upper extremity has been shown to be a valid clinical tool for restoring controlled movement in the paralyzed hand. The current clinical system consists of a shoulder position transducer controlling an external microprocessor-based stimulator, which excites paralyzed muscle via the peripheral nerve using percutaneous leads or a multichannel, implantable stimulator. Tendon transfer surgery of paralyzed but innervated muscle may augment the neurologically deficient upper extremity by allowing the substitution of stronger motors or the addition of new motors where flaccid paralysis (dennervation) eliminates the usual muscle from a grasp pattern. Sensory feedback in the form of machine state and cognitive information can be provided to the normally innervated C5 dermatome skin by subcutaneous electrodes. C5- and C6-level tetraplegics using FNS can independently perform single-hand manipulative tasks at a level similar to that of subjects with intact C7 roots, although they lack the elbow control.
对C5和C6四肢瘫痪患者的上肢进行功能性神经肌肉刺激（FNS）已被证明是一种有效的临床工具，可用于恢复瘫痪手部的可控运动。当前的临床系统包括一个肩部位置传感器，它控制一个基于微处理器的外部刺激器，该刺激器通过经皮导线或多通道植入式刺激器，经外周神经刺激瘫痪肌肉。对瘫痪但仍有神经支配的肌肉进行肌腱转移手术，可以通过用更强的肌肉替代或在弛缓性麻痹（失神经支配）导致正常抓握模式的肌肉缺失时增加新的肌肉，来增强神经功能缺陷的上肢。机器状态和认知信息形式的感觉反馈可以通过皮下电极提供给正常神经支配的C5皮节皮肤。使用FNS的C5和C6水平四肢瘫痪患者能够独立完成单手操作任务，其水平与C7神经根完整的受试者相似，尽管他们缺乏肘部控制能力。
