Felder John M, Saoud Karim
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2023 Feb 13;11(2):e4801. doi: 10.1097/GOX.0000000000004801. eCollection 2023 Feb.
Chronic neuropathic pain following major limb amputation has historically been difficult to treat. In patients undergoing lower extremity amputation, "preemptive" targeted muscle reinnervation (TMR) nerve transfers may be performed concurrently with the amputation to help mitigate the risk of chronic neuropathic postoperative pain. Despite clinical studies demonstrating efficacy of TMR in lower extremity amputations, few procedural descriptions have been written, and none have been written regarding performing TMR at the knee disarticulation (KD) level of amputation. Although uncommonly utilized, the KD amputation has clear functional benefits over other levels of amputation for nonambulatory patients. As nonambulatory patients are also subject to the occurrence of chronic neuropathic postamputation pain, it stands to reason that the addition of TMR to KD surgery could be an improvement to standard techniques. In this report, we provide a technical description for concurrent TMR with KD and describe the rationale for its use.
从历史上看，大肢体截肢后的慢性神经性疼痛一直难以治疗。在接受下肢截肢的患者中，“预防性”靶向肌肉神经再支配（TMR）神经移植可在截肢时同时进行，以帮助降低术后慢性神经性疼痛的风险。尽管临床研究表明TMR在下肢截肢中有效，但很少有关于该手术过程的描述，而且没有关于在膝关节离断（KD）截肢水平进行TMR的描述。尽管KD截肢很少使用，但对于非步行患者而言，它比其他截肢水平具有明显的功能优势。由于非步行患者也会出现截肢后慢性神经性疼痛，因此在KD手术中增加TMR可能是对标准技术的一种改进。在本报告中，我们提供了KD同时进行TMR的技术描述，并阐述了其使用原理。
