Henderson Joshua T, Koenig Zachary A, Climov Mihail, Gelman Jack
Department of Surgery, Division of Plastic, Reconstructive and Hand Surgery, West Virginia University, Morgantown, W.Va.
Plast Reconstr Surg Glob Open. 2023 Mar 13;11(3):e4894. doi: 10.1097/GOX.0000000000004894. eCollection 2023 Mar.
Targeted muscle reinnervation (TMR) outcome studies reveal the benefit amputees experience and the potential functional improvement by optimizing neurocutaneous signaling for myoelectric prosthesis control. However, there are still many settings where these techniques are not offered to patients requiring lower extremity amputations or neuroma reconstruction. With growing consistency in the literature, it is helpful to systematize the nerve transfers described for lower extremity TMR and to simplify its integration into reconstructive care.
A systematic literature review was performed and contained the following inclusion criteria: original cases of primary or secondary lower extremity amputation defects or nerve-related pain that underwent TMR with clearly described target muscles for each nerve transfer. Studies were excluded if the cases had been previously described or contained incomplete data. The primary outcomes were nerves transferred and muscles targeted. Target muscle options were presented in tables specific to anatomic region, and cross-sectional schematics were created for intraoperative assistance.
Seventeen studies presenting original cases with clearly described nerve transfers and target muscles in the lower extremity were included in the review. Target muscle selection for all nerve transfers at the transfemoral and transtibial levels were presented in separate tables.
Reports of early experience at multiple institutions identify trends in the selection of certain target muscles for nerve transfers in transfemoral and transtibial TMR. Familiarity with these common target muscles and nerve transfers can simplify intraoperative decision-making and enhance integration of lower extremity TMR in amputation care and in the treatment of nerve-related pain.
靶向肌肉再支配（TMR）结果研究揭示了截肢者通过优化用于肌电假肢控制的神经皮肤信号所获得的益处以及潜在的功能改善。然而，在许多情况下，这些技术并未提供给需要下肢截肢或神经瘤重建的患者。随着文献中越来越多的一致性，将下肢TMR中描述的神经移植方法系统化并简化其在重建护理中的整合是有帮助的。
进行了一项系统的文献综述，包含以下纳入标准：原发性或继发性下肢截肢缺损或神经相关疼痛的原始病例，这些病例接受了TMR，且每种神经移植的目标肌肉都有清晰描述。如果病例之前已被描述或包含不完整的数据，则将其排除。主要结果是移植的神经和目标肌肉。目标肌肉选项在特定解剖区域的表格中列出，并创建横断面示意图以辅助手术。
该综述纳入了17项研究，这些研究呈现了下肢神经移植和目标肌肉描述清晰的原始病例。分别列出了经股骨和经胫骨水平所有神经移植的目标肌肉选择。
多个机构早期经验的报告确定了经股骨和经胫骨TMR中神经移植特定目标肌肉选择的趋势。熟悉这些常见的目标肌肉和神经移植可以简化术中决策，并加强下肢TMR在截肢护理和神经相关疼痛治疗中的整合。
