Berger Lauren E, Shin Stephanie, Haffner Zoë K, Huffman Samuel S, Spoer Daisy L, Sayyed Adaah A, Franzoni Garrett, Bekeny Jenna C, Attinger Christopher E, Kleiber Grant M
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States.
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States.
Microsurgery. 2023 Oct;43(7):736-747. doi: 10.1002/micr.31030. Epub 2023 Mar 2.
Targeted muscle reinnervation (TMR) is a promising surgical modality for reducing post-amputation pain. We sought to provide a succinct overview of TMR specific to the lower extremity (LE) amputation population.
A systematic review was performed per PRISMA guidelines. Ovid MEDLINE, PubMed, and Web of Science were queried for records using various combinations of Medical Subject Heading (MeSH) terms such as "LE "amputation," "below-knee amputation" (BKA), "above-knee amputation" (AKA), and "TMR." Primary outcomes included (1) operative techniques, (2) changes in neuroma, phantom limb pain (PLP), or residual limb pain (RLP), and (3) postoperative complications. Studies were only included if outcomes data were discretely provided for LE patients.
Eleven articles examining 318 patients were identified. Average patient age was 47.5 ± 9.3 years, and most patients were male (n = 246, 77.4%). Eight manuscripts (72.7%) described TMR at the index amputation. The average number of nerve transfers performed per TMR case was 2.1 ± 0.8, and the most commonly employed nerve was the tibial (178/498; 35.7%). Nine (81.8%) articles incorporated patient-reported outcomes after TMR, with common methods including the Numerical Rating Scale (NRS) and questionnaires. Four studies (33.3%) reported functional outcomes such as ambulation ability and prosthesis tolerance. Complications were described in seven manuscripts (58.3%), with postoperative neuroma development being the most common (21/371; 7.2%).
The application of TMR to LE amputations is effective in reducing PLP and RLP with limited complications. Continued investigations are warranted to better understand patient outcomes specific to anatomic location using validated patient-reported outcome measures (PROM).
靶向肌肉再支配术（TMR）是一种很有前景的手术方式，可减轻截肢后疼痛。我们试图对下肢（LE）截肢人群特有的TMR进行简要概述。
按照PRISMA指南进行系统综述。使用医学主题词（MeSH）术语的各种组合，如“LE截肢”“膝下截肢”（BKA）、“膝上截肢”（AKA）和“TMR”，在Ovid MEDLINE、PubMed和Web of Science中查询记录。主要结局包括：（1）手术技术；（2）神经瘤、幻肢痛（PLP）或残肢痛（RLP）的变化；（3）术后并发症。仅纳入为LE患者单独提供结局数据的研究。
共识别出11篇研究318例患者的文章。患者平均年龄为47.5±9.3岁，大多数患者为男性（n = 246，77.4%）。8篇手稿（72.7%）描述了初次截肢时的TMR。每例TMR病例平均进行的神经移植数量为2.1±0.8，最常用的神经是胫神经（178/498；35.7%）。9篇（81.8%）文章纳入了TMR术后患者报告的结局，常用方法包括数字评分量表（NRS）和问卷调查。4项研究（33.3%）报告了步行能力和假肢耐受性等功能结局。7篇手稿（58.3%）描述了并发症，术后神经瘤形成最为常见（21/371；7.2%）。
TMR应用于LE截肢在减轻PLP和RLP方面有效，并发症有限。有必要继续开展研究，使用经过验证的患者报告结局测量（PROM）更好地了解特定解剖部位的患者结局。
