[上肢大截肢后的假肢装配概念--当前可能性概述]。

IF 0.4 4区 医学 Q4 SURGERY Handchirurgie Mikrochirurgie Plastische Chirurgie Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI:10.1055/a-2260-9842
Leopold Harnoncourt, Clemens Gstoettner, Gregor Laengle, Anna Boesendorfer, Oskar Aszmann
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引用次数: 0

摘要

背景:上肢,尤其是手部,是患者与环境互动的关键,因此截肢或严重损伤导致手部功能丧失会严重影响患者的生活质量。在生物重建不可行或无法取得足够成功的情况下,仿生重建在患者护理中发挥着关键作用。传统的肌电假肢是通过残肢肌肉区域的表面电极产生的两个信号来控制的。这样,假肢的控制,尤其是对高位截肢者的控制,就会受到限制,而且非常麻烦。靶向肌肉神经再支配(TMR)手术技术提供了一种创新的解决方案:因截肢而失去目标器官的主要手臂神经被重新连接到残肢部位的肌肉。患者/材料和方法:我们对 TMR 和仿生重建进行了有选择性的文献综述,纳入了相关文章,并结合我们研究小组的临床经验对其进行了讨论。此外,还介绍了一个临床病例:结果:仿生重建与靶向肌肉神经再支配相结合,可以实现直观的假肢控制,同时移动各种假肢自由度,治疗神经瘤和幻肢痛。要想取得长期成功,患者必须高度服从,并在假肢康复阶段接受强化信号训练。尽管技术不断进步,但挑战依然存在,尤其是在增强信号传输和将自然感觉反馈整合到仿生假肢中方面:TMR手术是截肢者仿生治疗的一大进步。采用选择性神经转移进行信号倍增和放大,为改善肌电假肢功能提供了可能性,从而加强了对患者的护理。外部假体组件领域的进步、骨结合带来的骨骼连接的改善,以及使用无线、完全植入式电极系统的更流畅的信号传输,将使仿生重建在运动精度和体现方面取得重大进展。
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[Prosthetic Fitting Concepts after Major Amputation in the Upper Limb - an Overview of Current Possibilities].

Background: The upper extremity and particularly the hands are crucial for patients in interacting with their environment, therefore amputations or severe damage with loss of hand function significantly impact their quality of life. In cases where biological reconstruction is not feasible or does not lead to sufficient success, bionic reconstruction plays a key role in patient care. Classical myoelectric prostheses are controlled using two signals derived from surface electrodes in the area of the stump muscles. Prosthesis control, especially in high amputations, is then limited and cumbersome. The surgical technique of Targeted Muscle Reinnervation (TMR) offers an innovative solution: The major arm nerves that have lost their target organs due to amputation are rerouted to muscles in the stump area. This enables the establishment of cognitive control signals that allow significantly improved prosthesis control.

Patients/materials and methods: A selective literature review on TMR and bionic reconstruction was conducted, incorporating relevant articles and discussing them considering the clinical experience of our research group. Additionally, a clinical case is presented.

Results: Bionic reconstruction combined with Targeted Muscle Reinnervation enables intuitive prosthetic control with simultaneous movement of various prosthetic degrees of freedom and the treatment of neuroma and phantom limb pain. Long-term success requires a high level of patient compliance and intensive signal training during the prosthetic rehabilitation phase. Despite technological advances, challenges persist, especially in enhancing signal transmission and integrating natural sensory feedback into bionic prostheses.

Conclusion: TMR surgery represents a significant advancement in the bionic care of amputees. Employing selective nerve transfers for signal multiplication and amplification, opens up possibilities for improving myoelectric prosthesis function and thus enhancing patient care. Advances in the area of external prosthetic components, improvements in the skeletal connection due to osseointegration and more fluid signal transmission using wireless, fully implanted electrode systems will lead to significant progress in bionic reconstruction, both in terms of precision of movement and embodiment.

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来源期刊
CiteScore
1.00
自引率
16.70%
发文量
85
审稿时长
6-12 weeks
期刊介绍: In Originalarbeiten und Fallberichten finden Sie die neuesten Informationen über: Diagnostik Verfahrenswahl state of the art / neueste Techniken rekonstruktive Verfahren Behandlung infolge von Traumata oder OP Bewertung der Ergebnisse Klinische Forschung Interessante Darstellung der neuesten Erkenntnisse in Originalarbeiten und Fallberichten. Exzellent veranschaulicht durch ein klares Layout und reiche Bebilderung. Überzeugen Sie sich selbst! Organschaften Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie, Deutschen Gesellschaft für Handchirurgie und Österreichischen Gesellschaft für Handchirurgie Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße Organ der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen
期刊最新文献
[Palmar Displacement in Distal Radius Fractures following Extension Injuries of the Wrist]. [Dorsal Screw Osteosynthesis of a Scaphoid Nonunion associated with Congenital Scaphotrapezial and Lunotriquetral Coalitions: A Case Report]. [Autologous Breast Reconstruction and Radiotherapy: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)]. [Commentary on the Article of Philipp Moog, Edith Gawlik, Stefan Eisenreich et al. The Cost of Lipedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs Of Lipedema (Stage III) at a German University Clinic]. [The Cost of Lipoedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs of Lipoedema (Stage III) at a German University Clinic].
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