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

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Plastic and Aesthetic Research 2022年第1期9卷 1-13页

作者： Yazan Al-Ajam alexander woollard Norbert Kang Plastic and Reconstructive Surgery Royal Free London NHS Foundation TrustPond Street LondonLondon NW32QGUnited Kingdom

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“spare”muscles 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.

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

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An analysis of the role of targeted muscle reinnervation(TMR)in quality of life and pain outcomes:a case series

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Plastic and Aesthetic Research 2023年第1期10卷 663-669页

作者： David Zargaran Raveenjot Nagra alexander Zargaran Medha Akella Yazan Ajam Alex woollard NorbertKang Department of Plastic Surgery Royal Free HospitalPond StreetLondon NW32QGUnited Kingdom

Aim:Targeted muscle reinnervation(TMR)surgery has fundamentally changed the management of patients who have suffered or are about to undergo *** nerve stumps with a muscle target has been shown to have profound effects on levels of post-amputation pain in relation to phantom limb pain(PLP)and neuroma pain(NP).The primary objective of this report was to quantify pain parameters for this population and to measure the impact on health-related quality of life(HRQol)before and after TMR *** this case series,we evaluate the role of TMR in addressing both pain and the impact of the surgery on the patient’s quality of ***:A retrospective analysis of 15 upper limb amputee patients who underwent TMR by the Relimb Unit in London,***’perceptions of pain were determined using the 11-point numerical(Pain)rating scale(NRS)and HRQoL was calculated using the Euroqol EQ-5D-5L questionnaire at two time points,comparing both pain and perceived quality of life pre and post *** Wilcoxon Signed Rank Test was used for the NRS data and a paired sample t-test was used for the EQ-VAS ***:A total of 15 patients completed the *** observed statistically significant reductions in both PLP(pre-operative mean:7.6,post-operative mean:2.7,P<0.05)and NP(pre-operative mean:6.4,post-operative mean:2.5,P<0.05)in these ***,HRQoL observed on the EQ-VAS scale demonstrated a significant improvement in quality of life,from 68 pre-operatively to 78 post-procedure(P<0.05).Conclusion:This is the first quantified evaluation of changes in HRQoL after TMR surgery for upper limb *** appears to be a significant improvement in both HRQoL and overall perception of *** finding may have important implications for funding and national resource allocation for TMR surgery.

关键词： Amputation TMR targeted muscle reinnervation quality of life QALY

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