Mathieu Laurent, Redais Claire, Diner Constance, Lemaire-Petit Aurore, Milaire Alexia, Chataigneau Anaïs, Pfister Georges, de L'Escalopier Nicolas
Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, Clamart, 92140, France.
Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 place d'Arsonval, Lyon, 69003, France.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):37. doi: 10.1007/s00068-024-02701-w.
Targeted muscle reinnervation (TMR) is a technique that has proven effective for the treatment and prevention of chronic pain following amputation, though its adoption remains limited. The authors report on their initial experience using TMR.
A prospective study was conducted in a military trauma center involving traumatic amputees treated with either curative or preemptive TMR. Their outcomes were compared to those of control patients who underwent neuroma burial or simple neurectomy during primary amputation. Data included a numerical rating scale (NRS) and patient-reported outcomes measurement information System (PROMIS) scores evaluating residual limb pain (RLP) and phantom limb pain (PLP).
Eighteen patients with a median age of 45.5 years were included and followed up for a median period of 13 months. The curative TMR group consisted of 8 patients whose results were compared to those of 9 control patients. There was a significant reduction in almost all pain scores with TMR and only in RPL NRS scores with neuroma burial. Reduction in RLP and PLP scores was significantly greater with TMR. The preemptive TMR group included 10 patients whose results were compared to those of 18 control patients. No significant difference was observed in the postoperative evolution of RLP or PLP.
These results confirm the benefits of TMR for the curative treatment of RLP and PLP. However, within the limits of this small sample size, preemptive TMR did not show added value. TMR appears to be a complex technique that requires a learning curve.
靶向肌肉神经再支配（TMR）是一种已被证明对治疗和预防截肢后慢性疼痛有效的技术，但其应用仍然有限。作者报告了他们使用TMR的初步经验。
在一家军事创伤中心进行了一项前瞻性研究，纳入接受根治性或预防性TMR治疗的创伤性截肢患者。将他们的结果与在初次截肢时接受神经瘤埋藏或单纯神经切除术的对照患者的结果进行比较。数据包括评估残肢疼痛（RLP）和幻肢疼痛（PLP）的数字评分量表（NRS）和患者报告结局测量信息系统（PROMIS）评分。
纳入18例患者，中位年龄45.5岁，中位随访期13个月。根治性TMR组由8例患者组成，其结果与9例对照患者的结果进行比较。TMR组几乎所有疼痛评分均显著降低，而神经瘤埋藏组仅RLP的NRS评分降低。TMR组RLP和PLP评分的降低幅度显著更大。预防性TMR组包括10例患者，其结果与18例对照患者的结果进行比较。在RLP或PLP的术后演变中未观察到显著差异。
这些结果证实了TMR对RLP和PLP根治性治疗的益处。然而，在这个小样本量的限制范围内，预防性TMR未显示出附加价值。TMR似乎是一种复杂的技术，需要一个学习曲线。
