Improved myoelectric prosthesis control accomplished using multiple nerve transfers
Improved myoelectric prosthesis control accomplished using multiple nerve transfers
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DOI：
10.1097/01.prs.0000242487.62487.fb
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发表时间：
2006-12-01
影响因子：
3.6
通讯作者：
Dumanian, Gregory A.
中科院分区：
文献类型：
--
作者：
Hijjawi, John B.;Kuiken, Todd A.;Dumanian, Gregory A.
背景：对于更远端的截肢，肩关节水平脱位假体的控制明显比假体更困难。截肢者在协调假体肩部、肘部、手腕和手/钩部件的不同功能方面存在严重困难。使用者必须将一个关节锁定在空间中的特定位置，然后才能移动不同的关节。方法：一名电损伤后双侧肩关节脱位的患者接受了一种新的神经移位程序，该程序旨在改善肌电假体的控制。正中、尺、尺、肌皮神经转移到胸大肌和胸小肌节的神经上。然后，当患者的大脑激活正常的上肢神经时，这些肌肉就会充当周围神经信号的生物放大器。因此，当患者认为“屈肘”时，转移的肌肉皮肤；神经发射，胸大肌的一段收缩。然后经皮检测肌电信号，使假肢肘部屈曲。结果：4例神经移位中有3例成功。其中一次神经转移出人意料地产生了两个独立的可控肌肉段。在神经移位后，用患者以前的肌电装置和目前的装置进行标准化测试。患者的功能改善了246%。结论：神经转移到小肌肉节段能够创造一个新的神经接口，以改善肌电假体的控制。这是使用标准的神经和皮瓣手术技术完成的，而不需要任何可植入的装置。
Background: The control of shoulder-level disarticulation prostheses is significantly more difficult than that of prostheses for more distal amputations. Amputees have significant difficulties coordinating the separate functions of prosthetic shoulder, elbow, wrist, and hand/hook components. The user must lock one joint at a particular position in space before subsequently moving a different joint.Methods: A patient with bilateral humeral disarticulations after an electrical injury underwent a novel nerve transfer procedure designed to improve the control of a myoelectric prosthesis. The median, radial, ulnar, and musculocutaneous nerves were transferred to the nerves of segments of the pectoralis major and minor muscles. Those muscles then act as bioamplifiers of peripheral nerve signals when the normal upper extremity nerves are activated by the patient's brain. Therefore, when the patient thinks "flex elbow," the transferred musculocutaneous; nerve fires, and a segment of the pectoralis major contracts. An electromyographic signal is then detected transcutaneously and causes the prosthetic elbow to flex.Results: Three of the four nerve transfers were successful. One of the nerve transfers unexpectedly yielded two separate controllable muscle segments. Standardized testing using a "box-and-blocks" apparatus was performed with the patient's previous myoelectric device and the current device after nerve transfers. The patient's performance improved by 246 percent.Conclusions: Nerve transfers to small muscle segments are capable of creating a novel neural inter-face for improved control of a myoelectric prosthesis. This is done using standard techniques of nerve and flap surgery, and without any implantable devices.