Fascicular Topography of the Human Median Nerve for Neuroprosthetic Surgery.
Fascicular Topography of the Human Median Nerve for Neuroprosthetic Surgery.
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用于神经修复手术的人类正中神经束状地形图。
DOI：
10.3389/fnins.2016.00286
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发表时间：
2016
影响因子：
4.3
通讯作者：
Navarro X
中科院分区：
文献类型：
--
作者：
Delgado-Martínez I;Badia J;Pascual-Font A;Rodríguez-Baeza A;Navarro X
神经工程最受欢迎的应用之一是手臂和人工假肢装置之间的通信，用于替换截肢的手或治疗周围神经损伤。为此，将电极放置在正中神经周围或内部，以作为记录和刺激来自神经束的神经信号的接口，神经束支配负责手部运动的肌肉。由于缺乏标准程序，外科医生的电极植入主要基于直觉，这可能导致神经假体的性能较差，因为神经界面的位置不理想。为了提供可以帮助神经修复外科医生完成该手术的形态数据，我们研究了人类正中神经沿着前臂和上臂的神经束地形图。我们首先描述了神经束内容物和分支模式。沿着手臂的长度。接下来，我们构建了正中神经的3D重建，以便我们可以分析与手臂水平相关的神经束形态特征。最后，我们的特点是运动内容的正中神经束在上臂。总的来说，这些结果表明，束组织发生在一个短段远端的上髁和保持不变，直到肌肉分支离开主干。根据我们的结果，可以根据电极类型和植入位置得出总体建议，以帮助和辅助神经假体手术。有创接口对于上臂和前臂最近端的三分之一更方便。神经外膜电极似乎是最适合的前臂段后，神经束已从主干分开。
One of the most sought-after applications of neuroengineering is the communication between the arm and an artificial prosthetic device for the replacement of an amputated hand or the treatment of peripheral nerve injuries. For that, an electrode is placed around or inside the median nerve to serve as interface for recording and stimulation of nerve signals coming from the fascicles that innervate the muscles responsible for hand movements. Due to the lack of a standard procedure, the electrode implantation by the surgeon is strongly based on intuition, which may result in poor performance of the neuroprosthesis because of the suboptimal location of the neural interface. To provide morphological data that can aid the neuroprosthetic surgeon with this procedure, we investigated the fascicular topography of the human median nerve along the forearm and upper arm. We first performed a description of the fascicular content and branching patterns along the length of the arm. Next we built a 3D reconstruction of the median nerve so we could analyze the fascicle morphological features in relation to the arm level. Finally, we characterized the motor content of the median nerve fascicles in the upper arm. Collectively, these results indicate that fascicular organization occurs in a short segment distal to the epicondyles and remains unaltered until the muscular branches leave the main trunk. Based on our results, overall recommendations based on electrode type and implant location can be drawn to help and aid the neuroprosthetic procedure. Invasive interfaces would be more convenient for the upper arm and the most proximal third of the forearm. Epineural electrodes seem to be most suitable for the forearm segment after fascicles have been divided from the main trunk.