Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, OH.
Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
J Hand Surg Am. 2021 Jan;46(1):72.e1-72.e10. doi: 10.1016/j.jhsa.2020.08.014. Epub 2020 Oct 22.
Targeted muscle reinnervation (TMR) is a technique for the management of peripheral nerves in amputation. Phantom limb pain (PLP) and residual limb pain (RLP) trouble many patients after amputation, and TMR has been shown to reduce this pain when performed after the initial amputation. We hypothesize that TMR at the time of amputation may improve pain for patients after major upper-extremity amputation.
We conducted a retrospective review of patients who underwent major upper-extremity amputation with TMR performed at the time of the index amputation (early TMR). Phantom limb pain and RLP intensity and associated symptoms were assessed using the numeric rating scale (NRS), the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity Short-Form 3a, the Pain Behavior Short-Form 7a, and the Pain Interference Short-Form 8a. The TMR cohort was compared with benchmarked data from a sample of upper-extremity amputees.
Sixteen patients underwent early TMR and were compared with 55 benchmark patients. More than half of early TMR patients were without PLP (62%) compared with 24% of controls. Furthermore, half of all patients were free of RLP compared with 36% of controls. The median PROMIS PLP intensity score for the general sample was 47 versus 38 in the early TMR sample. Patients who underwent early TMR reported reduced pain behaviors and interference specific to PLP (50 vs 53 and 41 vs 50, respectively). The PROMIS RLP intensity score was lower in patients with early TMR (36 vs 47).
This study demonstrates that early TMR is a promising strategy for treating pain and improving the quality of life in the upper-extremity amputee. Early TMR may preclude the need for additional surgery and represents an important technique for peripheral nerve surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
靶向肌肉神经再支配（TMR）是一种用于管理截肢后周围神经的技术。幻肢痛（PLP）和残肢痛（RLP）困扰着许多截肢后的患者，TMR 已被证明可在初次截肢后减轻这种疼痛。我们假设在截肢时进行 TMR 可能会改善上肢截肢患者的疼痛。
我们对接受 TMR 的上肢主要截肢患者进行了回顾性研究（早期 TMR）。使用数字评分量表（NRS）、患者报告的结果测量信息系统（PROMIS）疼痛强度简短形式 3a、疼痛行为简短形式 7a 和疼痛干扰简短形式 8a 评估幻肢痛和 RLP 强度及相关症状。将 TMR 队列与上肢截肢患者的基准数据进行比较。
16 例患者接受了早期 TMR，并与 55 例基准患者进行了比较。与对照组的 24%相比，超过一半的早期 TMR 患者没有 PLP（62%）。此外，所有患者中有一半没有 RLP，而对照组中有 36%。一般样本的 PROMIS PLP 强度中位数为 47，而早期 TMR 样本为 38。接受早期 TMR 的患者报告称，PLP 相关的疼痛行为和干扰减少（分别为 50 对 53 和 41 对 50）。早期 TMR 患者的 PROMIS RLP 强度评分较低（36 对 47）。
本研究表明，早期 TMR 是治疗上肢截肢患者疼痛和提高生活质量的一种有前途的策略。早期 TMR 可能无需进行额外手术，是周围神经手术的重要技术。
研究类型/证据水平：治疗性 IV 级。
