Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study
Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study
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DOI：
10.1016/s0140-6736(07)60193-7
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发表时间：
2007-02-03
期刊：
影响因子：
168.9
通讯作者：
Dumanian, Gregory A.
中科院分区：
文献类型：
--
作者：
Kuiken, Todd A.;Miller, Laura A.;Dumanian, Gregory A.
背景目前人工手臂的功能受到控制方法不足的限制。我们开发了一种技术，使用神经转移到肌肉，开发新的肌电图控制信号和神经转移到皮肤，皮肤感觉反馈到失踪hand.Methods提供了一个途径，我们做了有针对性的神经再支配手术的一名女子在肱骨颈左手臂截肢。尺骨，正中，肌肉皮肤，和远端。桡神经被转移到她的胸肌和锯肌的不同部分。切断两条感觉神经，远端与尺神经和正中神经吻合。完全恢复后，患者使用额外的靶向肌肉神经再支配部位安装了新的假体。功能测试和感觉在神经支配的皮肤quantited.Findings-病人描述的控制直观，她想用她的手或肘部和假体作出适当的反应。功能测试显示显著改善：块和箱测试的平均评分从传统假体的4.0（SD 1.0）增加到新假体的15.6（1.5）。运动技能和过程技能的评估测试分数从0.30增加到1.98运动技能和从0.90增加到1.98过程技能。失神经支配的前胸皮肤由尺神经和正中神经进行神经支配;患者感觉到她的手被触摸时，这胸部皮肤被触摸，与接近正常的阈值在所有的感官modals.Interpretation有针对性的神经支配改善假体功能和易用性在这个patient。有针对性的感觉神经再支配为有意义的感觉反馈提供了潜在的途径。
Background The function of current artificial arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand.Methods We did targeted reinnervation surgery on a woman with a left arm amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal. radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified.Findings The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4.0 (SD 1.0) with the conventional prosthesis to 15.6 (1.5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0.30 to 1.98 for motor skills and from 0.90 to 1.98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities.Interpretation Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback.