Implanted High Density Cuff Electrodes Functionally Activate Human Tibial and Peroneal Motor Units Without Chronic Detriment to Peripheral Nerve Health
Implanted High Density Cuff Electrodes Functionally Activate Human Tibial and Peroneal Motor Units Without Chronic Detriment to Peripheral Nerve Health
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DOI：
10.1111/ner.13110
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发表时间：
2020-03-18
期刊：
影响因子：
2.8
通讯作者：
Triolo, Ronald
中科院分区：
文献类型：
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作者：
Delianides, Christopher;Tyler, Dustin;Triolo, Ronald
目的采用多接触神经袖电极刺激周围神经，可有效恢复下肢瘫痪患者的神经功能。本研究调查了在人类志愿者膝盖以上的胫骨和腓神经上植入复合平面界面神经电极（C-FINE）一年后神经健康的临床测量。这是首次将新型NCE应用于具有独特挑战性的位置的新神经目标，该位置容易受到长时间的外力，因此急性和慢性术后观察至关重要。材料和方法一名27岁的男性，C3至C4水平不完全性脊髓损伤（AIS C），在膝关节近端两侧胫骨神经和腓神经上接受8次接触C-钉。通过临时经皮导联，每个袖带可接触4个触点，表现出最理想的反应。经皮导线随后被移除，接触产生最好的背屈（四个中的两个）和足底屈（四个中的一个），重新连接到永久植入的脉冲发生器。植入后13个月，通过运动神经传导速度（MNCV）研究、临床针肌电图、复合运动动作电位（CMAP）、感觉神经动作电位（SNAP）、刺激诱发破伤风瞬间收集和下肢周长测量来评估神经健康和袖带性能。结果胫骨和腓骨的mncv在40 m/sec以上保持稳定，cmap在6个月后增加或稳定。snap在所有测量中都保持稳定。CMAP初始充电阈值保持在50nc以下，在每个袖带的四次外部接触中，有三次肌肉恢复顺序变化最小。高峰破伤风时刻保持稳定，大腿和小腿的周长在一年内分别增加了5%和14%。结论膝上胫腓NCEs可恢复受刺激的踝关节功能，且无慢性神经健康损害。与先前的股神经数据一起，本研究证明了NCEs在有限的神经肌肉冲击下增强下肢功能的能力。
Objective Peripheral nerve stimulation via multi-contact nerve cuff electrodes (NCEs) has proved effective in restoring function to individuals with lower-extremity paralysis. This study investigates clinical measures of nerve health over one year post-implantation of a composite flat-interface nerve electrode (C-FINE) on the tibial and peroneal nerves above the knee in a human volunteer. This represents the first deployment of a novel NCE on new neural targets in a uniquely challenging location prone to prolonged externally applied forces, making acute and chronic postoperative observation critical.Materials and Methods A 27-year-old man with an incomplete spinal cord injury (AIS C) at the C3 to C4 level received eight-contact C-FINEs bilaterally on the tibial and peroneal nerves, proximal to the knee. Access to four contacts per cuff exhibiting the most desirable responses was externalized via temporary percutaneous leads. Percutaneous leads were later removed, with contacts generating the best dorsiflexion (two of four) and plantar flexion (one of four) reconnected to a permanently implanted pulse generator. For 13 months post-implantation, nerve health and cuff performance were assessed through motor nerve conduction velocity (MNCV) studies, clinical needle electromyography, compound motor action potential (CMAP), sensory nerve action potential (SNAP), stimulation-evoked tetanic moment collection, and lower-limb circumference measurements.Results Tibial and peroneal MNCVs remained stable bilaterally above 40 m/sec, with CMAPs increased or stable after six months. SNAPs remained stable across all measurements. CMAP initial charge thresholds remained below 50 nC, with minimal changes to muscle recruitment order in three of four externalized contacts per cuff. Peak tetanic moments remained stable, with bilateral increases in thigh and calf circumferences of 5% and 14% over one year.Conclusions Above-knee tibial and peroneal NCEs can restore stimulated ankle-joint function without chronic nerve health detriments. Alongside previous femoral nerve data, this study demonstrates the ability of NCEs to enhance lower-extremity function with limited neuromuscular impact.