Targeted Muscle Reinnervation for the Upper and Lower Extremity.
Targeted Muscle Reinnervation for the Upper and Lower Extremity.
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DOI：
10.1097/bto.0000000000000194
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Dumanian GA
中科院分区：
文献类型：
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作者：
Kuiken TA;Barlow AK;Hargrove L;Dumanian GA
肌电装置由通过残余肌肉的收缩产生的肌电信号控制，其因此充当神经控制信号的生物放大器。虽然被截肢切断的神经继续携带用于缺失肢体的运动控制信息，但由于截肢而导致的肌肉效应器的丧失阻止了对这一重要控制信息的访问。靶向肌肉神经再支配（TMR）是一种新的策略，以提高控制的肌电上肢假肢。切断的运动神经通过外科手术转移到失神经支配的目标肌肉的运动点，这些肌肉在神经再支配后响应于用于缺失肢体的神经控制信号而收缩。TMR创建了额外的控制部位，消除了在不同控制模式之间切换假体的需要。此外，目标肌肉的收缩和假体的操作响应于移动缺失肢体的尝试而发生，使得控制更容易和更直观。TMR已被广泛用于高位上肢截肢患者，并已被证明可改善功能性假肢控制。TMR的益处正在经桡动脉截肢和下肢截肢患者中进行研究。TMR也正在进行的临床试验中作为预防或治疗疼痛性截肢神经瘤的方法进行研究。
Myoelectric devices are controlled by electromyographic signals generated by contraction of residual muscles, which thus serve as biological amplifiers of neural control signals. Although nerves severed by amputation continue to carry motor control information intended for the missing limb, loss of muscle effectors due to amputation prevents access to this important control information. Targeted Muscle Reinnervation (TMR) was developed as a novel strategy to improve control of myoelectric upper limb prostheses. Severed motor nerves are surgically transferred to the motor points of denervated target muscles, which, after reinnervation, contract in response to neural control signals for the missing limb. TMR creates additional control sites, eliminating the need to switch the prosthesis between different control modes. In addition, contraction of target muscles, and operation of the prosthesis, occurs in reponse to attempts to move the missing limb, making control easier and more intuitive. TMR has been performed extensively in individuals with high-level upper limb amputations and has been shown to improve functional prosthesis control. The benefits of TMR are being studied in individuals with transradial amputations and lower limb amputations. TMR is also being investigated in an ongoing clinical trial as a method to prevent or treat painful amputation neuromas.