Targeted muscle reinnervation after traumatic or elective upper-extremity amputation: a systematic review and meta-analysis.
完整摘要 · 中文译文
目的：系统评价上肢截肢或严重臂丛神经损伤患者在接受靶向肌肉神经再支配（TMR）或基于TMR的重建术后，功能恢复和假肢控制情况。 方法：检索PubMed、Embase、Web of Science、Scopus和Cochrane Library，纳入报告TMR术前和术后标准化功能结局的研究。两名评价者独立进行研究筛选、数据提取和方法学质量评价，使用非随机研究方法学指数（MINORS）进行评估。由于大多数研究未报告配对变化的标准差或参与者内相关性，术前和术后汇总数据采用均数差（MDs）或标准化均数差（SMDs）作为探索性估计进行合成。通过比较研究中心、招募时间、作者身份和参与者特征，识别可能重叠的队列。 结果：共纳入6篇符合条件的报告，代表5个独立的患者队列。MINORS评分为9至12分（满分16分），提示存在重要的方法学局限性。术后南安普顿手部评估程序（SHAP）评分显著改善（MD = 31.45，95% CI 6.69-56.21），但观察到显著异质性（I 2 = 83%）。手臂、肩部和手部功能障碍（DASH）评分在方向统一后显示自报功能障碍显著降低（MD = 21.91，95% CI 10.85-32.97；I 2 = 0%）。一项单研究报告Ac tion Research Arm Test（ARAT）评分（MD = 22.00，95% CI 10.29-33.71），而另一项研究报告 OPUS 上肢功能评分增加（平均变化 = 2.7，95% CI 2.3-3.2）。纳入 TMR 联合骨整合的敏感性分析产生了相似的 DASH 效应。 结论：当前证据提示，基于 TMR 的重建可能改善假肢任务表现和感知上肢功能。然而，由于样本量小、手术方式异质、配对数据报告不完整以及 TMR 常被用于多组件重建方案中，这些发现仍属初步。需要采用标准化功能结局的更大规模前瞻性多中心研究。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002627，标识符（CRD420251002627）。
完整摘要 · 英文原文
OBJECTIVE: To systematically evaluate functional recovery and prosthetic control following targeted muscle reinnervation (TMR) or TMR-based reconstruction in patients with upper extremity amputation or severe brachial plexus injury. METHODS: PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched for studies reporting standardized functional outcomes before and after TMR. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Because most studies did not report the standard deviation of paired changes or within-participant correlations, preoperative and postoperative summary data were synthesized using mean differences (MDs) or standardized mean differences (SMDs) as exploratory estimates. Potentially overlapping cohorts were identified by comparing study centers, recruitment periods, authorship, and participant characteristics. RESULTS: Six eligible reports representing five independent patient cohorts were included. MINORS scores ranged from 9 to 12 out of 16, indicating important methodological limitations. Postoperative Southampton Hand Assessment Procedure (SHAP) scores improved significantly (MD = 31.45, 95% CI 6.69-56.21), although substantial heterogeneity was observed (I 2 = 83%). Disabilities of the Arm, Shoulder and Hand (DASH) scores showed a significant reduction in self-reported disability after direction harmonization (MD = 21.91, 95% CI 10.85-32.97; I 2 = 0%). A single study reported a significant improvement in Action Research Arm Test (ARAT) scores (MD = 22.00, 95% CI 10.29-33.71), while another reported an increase in OPUS upper-extremity function scores (mean change = 2.7, 95% CI 2.3-3.2). Sensitivity analysis including combined TMR and osseointegration produced a similar DASH effect. CONCLUSION: Current evidence suggests that TMR-based reconstruction may improve prosthetic task performance and perceived upper-limb function. However, the findings remain preliminary because of small samples, heterogeneous procedures, incomplete paired-data reporting, and the frequent use of TMR within multicomponent reconstructive programmes. Larger prospective multicenter studies using standardized functional outcomes are required. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002627, identifier (CRD420251002627).
摘要 待译
OBJECTIVE: To systematically evaluate functional recovery and prosthetic control following targeted muscle reinnervation (TMR) or TMR-based reconstruction in patients with upper extremity amputation or severe brachial plexus injury. METHODS: PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched for studies reporting standardized functional outcomes before and after TMR. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using the Methodological Index for Non-Randomized Studies (MINORS).…