Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria.
Center for Bionics and Pain Research, Mölndal, Sweden.
J Hand Surg Eur Vol. 2024 Jun;49(6):783-791. doi: 10.1177/17531934241227795. Epub 2024 Feb 16.
Selective nerve transfers are used in the setting of upper limb amputation to improve myoelectric prosthesis control. This surgical concept is referred to as targeted muscle reinnervation (TMR) and describes the rerouting of the major nerves of the arm onto the motor branches of the residual limb musculature. Aside from providing additional myosignals for prosthetic control, TMR can treat and prevent neuroma pain and possibly also phantom limb pain. This article reviews the history and current applications of TMR in upper limb amputation, with a focus on practical considerations. It further explores and identifies technological innovations to improve the man-machine interface in amputation care, particularly regarding implantable interfaces, such as muscle electrodes and osseointegration. Finally, future clinical directions and possible scientific avenues in this field are presented and critically discussed.
选择性神经转移术用于上肢截肢，以改善肌电假肢控制。这种手术概念被称为靶向肌肉再支配（TMR），描述了将手臂的主要神经重新连接到残肢肌肉的运动分支上。除了为假肢控制提供更多的肌电信号外，TMR 还可以治疗和预防神经瘤疼痛，并且可能还可以预防幻肢痛。本文回顾了 TMR 在上肢截肢中的历史和当前应用，重点介绍了实际考虑因素。它进一步探讨并确定了技术创新，以改善截肢护理中的人机界面，特别是关于可植入接口，如肌肉电极和骨整合。最后，提出并批判性地讨论了该领域的未来临床方向和可能的科学途径。
