Cox Cameron, Chen Andrew, Baum Gracie, Ibrahim Andrew F, Hernandez Evan, MacKay Brendan
Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Eplasty. 2025 Jun 27;25:e22. eCollection 2025.
Many amputees are left with chronic localized pain, centralized pain, and phantom limb pain or sensation, often resulting from neuromas in the residual limb. Historically, there is no reliably effective intervention for pain associated with neuroma-related residual or phantom limb pain. Targeted muscle reinnervation (TMR) is a surgical procedure first described in 2002 that involves the transfer of residual nerves from amputated limbs to new muscle targets. TMR has been shown to significantly reduce neuroma pain and facilitate the use of prostheses.
A prospective study was conducted of 61 patients who underwent TMR for neuroma treatment or prevention between 2017 and 2022. Primary outcomes included overall, phantom, and residual limb pain recorded using the Visual Analog Scale (VAS), as well as Patient-Reported Outcomes Measurement Information System (PROMIS) forms for Pain Intensity, Quality, Interference, and Behavior. Retrospective data was collected for a propensity-matched cohort of non-TMR amputees to compare pain outcomes.
TMR was performed for 25 upper extremity and 35 lower extremity amputations, and 5 patients underwent TMR on multiple limbs. Significant reductions were observed in overall limb pain (-3.2 points), phantom limb pain (-2.6 points), and residual limb pain (-3.0 points) for the TMR cohort. Mean PROMIS scores for TMR patients were 49.7 for Pain Intensity, 54.0 for Pain Quality, 55.3 for Pain Interference, and 56.1 for Pain Behavior. At the 8.4-month follow-up, 43.8% of TMR patients (vs 84% of controls) remained on neuromodulators, opioids, or both, for pain control.
TMR improved phantom and residual limb pain in amputees, as evidenced by clinically and statistically significant reductions in pain with reduced need for long-term opioids and/or neuromodulators. These findings support the current understanding of TMR but underscore the need for continued investigation to comprehensively assess the potential of this promising technique in improving the functional outcomes and quality of life in the amputee population.
许多截肢者会出现慢性局部疼痛、中枢性疼痛以及幻肢痛或幻肢感觉，这些通常是由残肢中的神经瘤引起的。从历史上看，对于与神经瘤相关的残肢或幻肢痛，没有可靠有效的干预措施。靶向肌肉再支配术（TMR）是一种于2002年首次描述的外科手术，该手术涉及将截肢肢体的残余神经转移到新的肌肉靶点。已证明TMR可显著减轻神经瘤疼痛并促进假肢的使用。
对2017年至2022年间接受TMR治疗或预防神经瘤的61例患者进行了一项前瞻性研究。主要结局包括使用视觉模拟量表（VAS）记录的总体疼痛、幻肢痛和残肢痛，以及患者报告结局测量信息系统（PROMIS）中关于疼痛强度、质量、干扰和行为的表格。收集了倾向匹配的非TMR截肢者队列的回顾性数据，以比较疼痛结局。
TMR手术用于25例上肢截肢和35例下肢截肢，5例患者在多个肢体上接受了TMR手术。TMR队列的总体肢体疼痛（-3.2分）、幻肢痛（-2.6分）和残肢痛（-3.0分）均有显著减轻。TMR患者的PROMIS平均得分在疼痛强度方面为49.7分，疼痛质量方面为54.0分，疼痛干扰方面为55.3分，疼痛行为方面为56.1分。在8.4个月的随访中，43.8%的TMR患者（对照组为84%）仍在使用神经调节剂、阿片类药物或两者来控制疼痛。
TMR改善了截肢者的幻肢痛和残肢痛，临床和统计学上疼痛显著减轻以及对长期阿片类药物和/或神经调节剂需求减少证明了这一点。这些发现支持了目前对TMR的理解，但强调需要继续进行研究，以全面评估这项有前景的技术在改善截肢者人群功能结局和生活质量方面的潜力。
