Sharma M, Marsolais E B, Polando G, Triolo R J, Davis J A, Bhadra N, Uhlir J P
Department of Veterans Affairs Medical Center, Cleveland, OH 44106-1702, USA.
Clin Orthop Relat Res. 1998 Feb(347):236-42.
A 16-channel electrical stimulation system was implanted in a 39-year-old patient with T10 paraplegia to restore sit to stand, walking, and exercise functions. System implantation required two surgical sessions. In the first session, the posterior muscle set consisting of bilateral semimembranosus, adductor magnus, and gluteus maximus muscles were exposed and epimysial electrodes sutured at the point of greatest muscle contraction. Closed double helix intramuscular electrodes were implanted in the erector spinae. Two weeks later, epimysial electrodes were attached to the eight anterior muscles consisting of the tibialis anterior, sartorius, tensor fasciae latae, and vastus lateralis with all 16 electrode leads passed to the anterior abdominal wall. The electrodes were connected to two eight-channel stimulators placed in the iliac fossae, and the system was checked by activating the individual muscles. The implanted stimulators received stimulation instructions and power via a radio frequency link to an external control. Stimulation patterns for standing, walking, sitting, and exercise functions were chosen from a preprogrammed menu via a finger key pad. After 3 weeks of restricted patient activity, all electrodes stimulated either the target muscle or had an acceptable spillover pattern. The patient is undergoing a 16-week rehabilitation course of stimulated exercises gradually increasing in intensity. At the conclusion, the goal is to discharge the patient with the system for spontaneous use. Although long term followup is required to determine system reliability, preliminary clinical results indicate that targeted, repeatable, functional muscle contractions in the lower extremity can be achieved with a system consisting of epimysial electrodes.
一个16通道电刺激系统被植入一名39岁的T10截瘫患者体内，以恢复从坐到站、行走及运动功能。系统植入需要进行两次手术。在第一次手术中，暴露由双侧半膜肌、大收肌和臀大肌组成的后部肌群，并在肌肉收缩最强烈的部位缝合肌外膜电极。将闭合双螺旋肌内电极植入竖脊肌。两周后，将肌外膜电极连接到由胫骨前肌、缝匠肌、阔筋膜张肌和股外侧肌组成的八块前部肌肉上，所有16根电极导线都引至前腹壁。电极连接到置于髂窝的两个八通道刺激器上，并通过激活各个肌肉来检查系统。植入的刺激器通过射频链路接收来自外部控制器的刺激指令和能量。通过手指键盘从预编程菜单中选择站立、行走、坐立和运动功能的刺激模式。在患者活动受限3周后，所有电极均能刺激目标肌肉或具有可接受的溢出模式。患者正在接受为期16周的刺激运动康复课程，强度逐渐增加。康复结束时，目标是让患者带着该系统出院以便自行使用。虽然需要长期随访来确定系统的可靠性，但初步临床结果表明，使用由肌外膜电极组成的系统可以实现下肢有针对性的、可重复的功能性肌肉收缩。
