Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Yao ¹ , ZHAO Wei ¹ , HUANG Jianping ² , SHEN Mingkui ¹ , LI Sijing ¹ , LIU Cheng ¹ , SU Xiuyun ³ , LI Guanglin ² , BI Sheng ⁴ ,  PEI Guoxian ^1,3

1. Medical College of Southern University of Science and Technology, Shenzhen Guangdong, 518055, P. R. China;
2. Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen Guangdong, 518055, P. R. China;
3. Department of Orthopedics, Southern University of Science and Technology Hospital, Shenzhen Guangdong, 518055, P. R. China;
4. National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China;

Corresponding author：

PEI Guoxian, Email: nfperry@163.com

Keywords：

Intelligent prosthesis; human-machine interface; pattern recognition; surface electromyography; targeted muscle reinnervation

DOI：

10.7507/1002-1892.202304045

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. Methods Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. Results TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the “brain-spinal cord-peripheral nerve-skeletal muscle” neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. Conclusion TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.

Citation： GUO Yao, ZHAO Wei, HUANG Jianping, SHEN Mingkui, LI Sijing, LIU Cheng, SU Xiuyun, LI Guanglin, BI Sheng, PEI Guoxian. Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 1021-1025. doi: 10.7507/1002-1892.202304045 Copy

1.	Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil, 2008, 89(3): 422-429.
2.	Dubernard JM, Owen E, Herzberg G, et al. Human hand allograft: report on first 6 months. Lancet, 1999, 353(9161): 1315-1320.
3.	Wells MW, Rampazzo A, Papay F, et al. Two decades of hand transplantation: A systematic review of outcomes. Ann Plast Surg, 2022, 88(3): 335-344.
4.	Billard A, Kragic D. Trends and challenges in robot manipulation. Science, 2019, 364(6446): eaat8414.
5.	Aman M, Sporer ME, Gstoettner C, et al. Bionic hand as artificial organ: Current status and future perspectives. Artif Organs, 2019, 43(2): 109-118.
6.	Ortiz-Catalan M, Mastinu E, Sassu P, et al. Self-contained neuromusculoskeletal arm prostheses. N Engl J Med, 2020, 382(18): 1732-1738.
7.	Bergmeister KD, Salminger S, Aszmann OC. Targeted muscle reinnervation for prosthetic control. Hand Clin, 2021, 37(3): 415-424.
8.	Johnson CC, Loeffler BJ, Gaston RG. Targeted muscle reinnervation: A paradigm shift for neuroma management and improved prosthesis control in major limb amputees. J Am Acad Orthop Surg, 2021, 29(7): 288-296.
9.	Todd AK, Aimee ES, Ann KB. Targeted muscle reinnervation: a neural interface for artificial limbs. Illinois: CRC Press, 2013: 22-42.
10.	徐瑞, 李志才, 王雯婕, 等. 基于肌电的人机交互控制策略及其应用与挑战. 电子测量与仪器学报, 2020, 32(2): 1-11.
11.	Salminger S, Sturma A, Roche AD, et al. Outcomes, challenges, and pitfalls after targeted muscle reinnervation in high-level amputees: Is it worth the effort? Plast Reconstr Surg, 2019, 144(6): 1037e-1043e.
12.	Vujaklija I, Farina D, Aszmann OC. New developments in prosthetic arm systems. Orthop Res Rev, 2016, 8: 31-39.
13.	Mereu F, Leone F, Gentile C, et al. Control strategies and performance assessment of upper-limb TMR prostheses: A review. Sensors (Basel), 2021, 21(6): 1953.
14.	黄品高. 智能下肢假肢运动意图的感测与识别关键技术研究. 深圳: 中国科学院大学 (中国科学院深圳先进技术研究院), 2020.
15.	Campbell E, Phinyomark A, Scheme E. Current trends and confounding factors in myoelectric control: Limb position and contraction intensity. Sensors (Basel), 2020, 20(6): 1613.
16.	Kuiken TA, Li G, Lock BA, et al. Targeted muscle reinnervation for real-time myoelectric control of multifunction artificial arms. JAMA, 2009, 301(6): 619-628.
17.	Gart MS, Souza JM, Dumanian GA. Targeted muscle reinnervation in the upper extremity amputee: A technical roadmap. J Hand Surg (Am), 2015, 40(9): 1877-1888.
18.	Pierrie SN, Gaston RG, Loeffler BJ. Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation. J Hand Surg (Am), 2019, 44(6): 525.e1-525.e8.
19.	Elmaraghi S, Albano NJ, Israel JS, et al. Targeted muscle reinnervation in the hand: Treatment and prevention of pain after ray amputation. J Hand Surg (Am), 2020, 45(9): 884.e1-884.e6.
20.	Hobusch GM, Döring K, Brånemark R, et al. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev, 2020, 5(10): 724-741.
21.	Hargrove LJ, Simon AM, Young AJ, et al. Robotic leg control with EMG decoding in an amputee with nerve transfers. N Engl J Med, 2013, 369(13): 1237-1242.
22.	Daugherty THF, Parikh R, Mailey BA, et al. Surgical technique for below-knee amputation with concurrent targeted muscle reinnervation. Plast Reconstr Surg Glob Open, 2020, 8(7): e2990.
23.	Aszmann OC, Roche AD, Salminger S, et al. Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients. Lancet, 2015, 385(9983): 2183-2189.
24.	Verdú E, Ceballos D, Vilches JJ, et al. Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst, 2000, 5(4): 191-208.
25.	Dumanian GA, Potter BK, Mioton LM, et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: A randomized clinical trial. Ann Surg, 2019, 270(2): 238-246.
26.	Oh C, Carlsen BT. New innovations in targeted muscle reinnervation: A critical analysis review. JBJS Rev, 2019, 7(6): e3.
27.	Cheesborough JE, Smith LH, Kuiken TA, et al. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg, 2015, 29(1): 62-72.
28.	Valerio IL, Dumanian GA, Jordan SW, et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg, 2019, 228(3): 217-226.
29.	Mioton LM, Dumanian GA, Shah N, et al. Targeted muscle reinnervation improves residual limb pain, phantom limb pain, and limb function: A prospective study of 33 major limb amputees. Clin Orthop Relat Res, 2020, 478(9): 2161-2167.
30.	Chang BL, Mondshine J, Attinger CE, et al. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg, 2021, 148(2): 376-386.
31.	Agnew SP, Schultz AE, Dumanian GA, et al. Targeted reinnervation in the transfemoral amputee: a preliminary study of surgical technique. Plast Reconstr Surg, 2012, 129(1): 187-194.
32.	Fracol ME, Janes LE, Ko JH, et al. Targeted muscle reinnervation in the lower leg: An anatomical study. Plast Reconstr Surg, 2018, 142(4): 541e-550e.
33.	Woo SL, Kung TA, Brown DL, et al. Regenerative peripheral nerve interfaces for the treatment of postamputation neuroma pain: A pilot study. Plast Reconstr Surg Glob Open, 2016, 4(12): e1038.
34.	黄剑平, 李文庆, 杨琳, 等. 上肢经肱骨截肢神经功能重建研究. 集成技术, 2016, 5(5): 30-37.
35.	Xu Y, Zhang D, Wang Y, et al. Two ways to improve myoelectric control for a transhumeral amputee after targeted muscle reinnervation: a case study. J Neuroeng Rehabil, 2018, 15(1): 37.
36.	杜群. 基于表面肌电信号的智能仿生手设计与研究. 徐州: 中国矿业大学, 2021.

1. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil, 2008, 89(3): 422-429.
2. Dubernard JM, Owen E, Herzberg G, et al. Human hand allograft: report on first 6 months. Lancet, 1999, 353(9161): 1315-1320.
3. Wells MW, Rampazzo A, Papay F, et al. Two decades of hand transplantation: A systematic review of outcomes. Ann Plast Surg, 2022, 88(3): 335-344.
4. Billard A, Kragic D. Trends and challenges in robot manipulation. Science, 2019, 364(6446): eaat8414.
5. Aman M, Sporer ME, Gstoettner C, et al. Bionic hand as artificial organ: Current status and future perspectives. Artif Organs, 2019, 43(2): 109-118.
6. Ortiz-Catalan M, Mastinu E, Sassu P, et al. Self-contained neuromusculoskeletal arm prostheses. N Engl J Med, 2020, 382(18): 1732-1738.
7. Bergmeister KD, Salminger S, Aszmann OC. Targeted muscle reinnervation for prosthetic control. Hand Clin, 2021, 37(3): 415-424.
8. Johnson CC, Loeffler BJ, Gaston RG. Targeted muscle reinnervation: A paradigm shift for neuroma management and improved prosthesis control in major limb amputees. J Am Acad Orthop Surg, 2021, 29(7): 288-296.
9. Todd AK, Aimee ES, Ann KB. Targeted muscle reinnervation: a neural interface for artificial limbs. Illinois: CRC Press, 2013: 22-42.
10. 徐瑞, 李志才, 王雯婕, 等. 基于肌电的人机交互控制策略及其应用与挑战. 电子测量与仪器学报, 2020, 32(2): 1-11.
11. Salminger S, Sturma A, Roche AD, et al. Outcomes, challenges, and pitfalls after targeted muscle reinnervation in high-level amputees: Is it worth the effort? Plast Reconstr Surg, 2019, 144(6): 1037e-1043e.
12. Vujaklija I, Farina D, Aszmann OC. New developments in prosthetic arm systems. Orthop Res Rev, 2016, 8: 31-39.
13. Mereu F, Leone F, Gentile C, et al. Control strategies and performance assessment of upper-limb TMR prostheses: A review. Sensors (Basel), 2021, 21(6): 1953.
14. 黄品高. 智能下肢假肢运动意图的感测与识别关键技术研究. 深圳: 中国科学院大学 (中国科学院深圳先进技术研究院), 2020.
15. Campbell E, Phinyomark A, Scheme E. Current trends and confounding factors in myoelectric control: Limb position and contraction intensity. Sensors (Basel), 2020, 20(6): 1613.
16. Kuiken TA, Li G, Lock BA, et al. Targeted muscle reinnervation for real-time myoelectric control of multifunction artificial arms. JAMA, 2009, 301(6): 619-628.
17. Gart MS, Souza JM, Dumanian GA. Targeted muscle reinnervation in the upper extremity amputee: A technical roadmap. J Hand Surg (Am), 2015, 40(9): 1877-1888.
18. Pierrie SN, Gaston RG, Loeffler BJ. Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation. J Hand Surg (Am), 2019, 44(6): 525.e1-525.e8.
19. Elmaraghi S, Albano NJ, Israel JS, et al. Targeted muscle reinnervation in the hand: Treatment and prevention of pain after ray amputation. J Hand Surg (Am), 2020, 45(9): 884.e1-884.e6.
20. Hobusch GM, Döring K, Brånemark R, et al. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev, 2020, 5(10): 724-741.
21. Hargrove LJ, Simon AM, Young AJ, et al. Robotic leg control with EMG decoding in an amputee with nerve transfers. N Engl J Med, 2013, 369(13): 1237-1242.
22. Daugherty THF, Parikh R, Mailey BA, et al. Surgical technique for below-knee amputation with concurrent targeted muscle reinnervation. Plast Reconstr Surg Glob Open, 2020, 8(7): e2990.
23. Aszmann OC, Roche AD, Salminger S, et al. Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients. Lancet, 2015, 385(9983): 2183-2189.
24. Verdú E, Ceballos D, Vilches JJ, et al. Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst, 2000, 5(4): 191-208.
25. Dumanian GA, Potter BK, Mioton LM, et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: A randomized clinical trial. Ann Surg, 2019, 270(2): 238-246.
26. Oh C, Carlsen BT. New innovations in targeted muscle reinnervation: A critical analysis review. JBJS Rev, 2019, 7(6): e3.
27. Cheesborough JE, Smith LH, Kuiken TA, et al. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg, 2015, 29(1): 62-72.
28. Valerio IL, Dumanian GA, Jordan SW, et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg, 2019, 228(3): 217-226.
29. Mioton LM, Dumanian GA, Shah N, et al. Targeted muscle reinnervation improves residual limb pain, phantom limb pain, and limb function: A prospective study of 33 major limb amputees. Clin Orthop Relat Res, 2020, 478(9): 2161-2167.
30. Chang BL, Mondshine J, Attinger CE, et al. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg, 2021, 148(2): 376-386.
31. Agnew SP, Schultz AE, Dumanian GA, et al. Targeted reinnervation in the transfemoral amputee: a preliminary study of surgical technique. Plast Reconstr Surg, 2012, 129(1): 187-194.
32. Fracol ME, Janes LE, Ko JH, et al. Targeted muscle reinnervation in the lower leg: An anatomical study. Plast Reconstr Surg, 2018, 142(4): 541e-550e.
33. Woo SL, Kung TA, Brown DL, et al. Regenerative peripheral nerve interfaces for the treatment of postamputation neuroma pain: A pilot study. Plast Reconstr Surg Glob Open, 2016, 4(12): e1038.
34. 黄剑平, 李文庆, 杨琳, 等. 上肢经肱骨截肢神经功能重建研究. 集成技术, 2016, 5(5): 30-37.
35. Xu Y, Zhang D, Wang Y, et al. Two ways to improve myoelectric control for a transhumeral amputee after targeted muscle reinnervation: a case study. J Neuroeng Rehabil, 2018, 15(1): 37.
36. 杜群. 基于表面肌电信号的智能仿生手设计与研究. 徐州: 中国矿业大学, 2021.

Chinese Journal of Reparative and Reconstructive Surgery

Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content