Karczewski Alison M, Zeng Weifeng, Stratchko Lindsay M, Bachus Kent N, Poore Samuel O, Dingle Aaron M
Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Front Neurosci. 2022 Apr 12;16:828593. doi: 10.3389/fnins.2022.828593. eCollection 2022.
As technology continues to improve within the neuroprosthetic landscape, there has been a paradigm shift in the approach to amputation and surgical implementation of haptic neural prosthesis for limb restoration. The Osseointegrated Neural Interface (ONI) is a proposed solution involving the transposition of terminal nerves into the medullary canal of long bones. This design combines concepts of neuroma formation and prevention with osseointegration to provide a stable environment for conduction of neural signals for sophisticated prosthetic control. While this concept has previously been explored in animal models, it has yet to be explored in humans. This anatomic study used three upper limb and three lower limb cadavers to assess the clinical feasibility of creating an ONI in humans. Anatomical measurement of the major peripheral nerves- circumference, length, and depth- were performed as they are critical for electrode design and rerouting of the nerves into the long bones. CT imaging was used for morphologic bone evaluation and virtual implantation of two osseointegrated implants were performed to assess the amount of residual medullary space available for housing the neural interfacing hardware. Use of a small stem osseointegrated implant was found to reduce bone removal and provide more intramedullary space than a traditional implant; however, the higher the amputation site, the less medullary space was available regardless of implant type. Thus the stability of the endoprosthesis must be maximized while still maintaining enough residual space for the interface components. The results from this study provide an anatomic basis required for establishing a clinically applicable ONI in humans. They may serve as a guide for surgical implementation of an osseointegrated endoprosthesis with intramedullary electrodes for prosthetic control.
随着神经假体领域的技术不断进步，截肢和用于肢体恢复的触觉神经假体的手术实施方法发生了范式转变。骨整合神经接口（ONI）是一种提出的解决方案，涉及将末梢神经移位到长骨的髓管中。这种设计将神经瘤形成和预防的概念与骨整合相结合，为神经信号传导提供稳定环境，以实现复杂的假肢控制。虽然这一概念此前已在动物模型中进行过探索，但尚未在人体中进行研究。这项解剖学研究使用了三具上肢尸体和三具下肢尸体，以评估在人体中创建ONI的临床可行性。对主要周围神经进行了解剖测量——周长、长度和深度——因为它们对于电极设计以及将神经重新路由到长骨中至关重要。CT成像用于形态学骨评估，并对两个骨整合植入物进行了虚拟植入，以评估可用于容纳神经接口硬件的剩余髓腔空间量。发现使用小型柄状骨整合植入物比传统植入物减少了骨切除并提供了更多的髓腔空间；然而，截肢部位越高，无论植入物类型如何，可用的髓腔空间就越少。因此，必须在最大限度提高假体稳定性的同时，仍为接口组件保留足够的剩余空间。这项研究的结果为在人体中建立临床适用的ONI提供了所需的解剖学基础。它们可为带有髓内电极用于假肢控制的骨整合假体的手术实施提供指导。
