Advances in upper limb loss rehabilitation:the role of targeted muscle reinnervation and regenerative peripheral nerve interfaces

作     者：Yazan Al-Ajam Alexander Woollard Norbert Kang Yazan Al-Ajam;Alexander Woollard;Norbert Kang

作者机构：Plastic and Reconstructive SurgeryRoyal Free London NHS Foundation TrustPond Street LondonLondon NW32QGUnited Kingdom 

出 版 物：《Plastic and Aesthetic Research》 (整形与美容研究（英文版）)

年 卷 期：2022年第9卷第1期

页      面：1-13页

学科分类：1001[医学-基础医学(可授医学、理学学位)] 10[医学] 

主　　题：Targeted muscle reinnervation regenerative peripheral nerve interface myoelectric prosthetic control neuroma pain phantom limb pain amputation 

摘      要：Upper limb loss results in significant physical and psychological impairment and is a major financial burden for both patients and healthcare *** myoelectric prostheses rely on electromyographic(EMG)signals captured using surface electrodes placed directly over antagonistic muscles in the residual stump to drive a single degree of freedom in the prosthetic limb(e.g.,hand open and close).In the absence of the appropriate muscle groups,patients rely on activation of biceps/triceps muscles alone(together with a mode switch)to control all degrees of freedom of the *** is a non-physiological method of control since it is non-intuitive and contributes poorly to daily *** leads to the high rate of prosthetic *** muscle reinnervation(TMR)reroutes the ends of nerves in the amputation stump to nerves innervating“sparemuscles in the amputation stump or chest *** then become proxies for the missing muscles in the amputated *** has revolutionised prosthetic control,especially for high-level amputees(e.g.,after shoulder disarticulation),resulting in more intuitive,fluid control of the *** can also reduce the intensity of symptoms such as neuroma and phantom limb *** peripheral nerve interface(RPNI)is another technique for increasing the number of control signals without the limitations of finding suitable target muscles imposed by *** involves wrapping a block of muscle around the free nerve ending,providing the regenerating axons with a target organ for *** RPNIs act as signal amplifiers of the previously severed nerves and their EMG signals can be used to control prosthetic *** can also reduce neuroma and phantom limb *** this review article,we discuss the surgical technique of TMR and RPNI and present outcomes from our experience with TMR.