From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Plast Reconstr Surg. 2019 Dec;144(6):1037e-1043e. doi: 10.1097/PRS.0000000000006277.
Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation.
Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017. Indications for targeted muscle reinnervation surgery differed between improvement of prosthetic function (n = 19) and/or pain (n = 11). Functional outcome was evaluated with the Action Research Arm Test, the Southampton Hand Assessment Procedure, and the Clothespin-Relocation Test. Functional evaluation was performed at least at 6 months after final prosthetic fitting.
All nerve transfers were successful and provided independent myoelectric signals. The 10 patients available for final functional evaluation showed Action Research Arm Test scores of 20.4 ± 1.9 and Southampton Hand Assessment Procedure scores of 40.5 ± 8.1. The Clothespin-Relocation Test showed a mean time of 34.3 ± 14.4 seconds.
Targeted muscle reinnervation has improved prosthetic control and revolutionized neuroma treatment in upper limb amputees. Still, the rate of abandonment even after targeted muscle reinnervation surgery has been shown high, and several advances within the biotechnological interface will be needed to improve prosthetic function and acceptance in these patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管近端上肢截肢患者失去了远端目标，但用于直观手和手臂功能的神经信号仍然存在，因此可以使用靶向肌肉再神经支配技术将其纳入更有用的假肢功能。在本文中，作者介绍了他们在 30 例肘上和肩离断水平截肢患者的靶向肌肉再神经支配病例中获得的结果和适应证范围，以及经验和陷阱。
2012 年至 2017 年间，共纳入 30 例肘上或肩离断截肢患者。靶向肌肉再神经支配手术的适应证为改善假肢功能（n=19）和/或减轻疼痛（n=11）。采用动作研究上肢测试、南安普顿手评估程序和别针移位测试评估功能结果。功能评估至少在最终假肢适配后 6 个月进行。
所有神经转移均成功，并提供了独立的肌电信号。10 例可进行最终功能评估的患者的动作研究上肢测试评分为 20.4±1.9，南安普顿手评估程序评分为 40.5±8.1。别针移位测试的平均时间为 34.3±14.4 秒。
靶向肌肉再神经支配改善了上肢截肢患者的假肢控制，彻底改变了神经瘤的治疗方法。尽管如此，即使在接受靶向肌肉再神经支配手术后，放弃的比例仍然很高，需要在生物技术接口方面取得一些进展，以改善这些患者的假肢功能和接受度。
临床问题/证据水平：治疗，IV。
