Exoprothetischer Ersatz bei Amputationen der oberen Extremität

 

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Zusammenfassung

Der prothetische Ersatz bei Amputationen an der oberen Extremität hat in den letzten Jahren einige Erneuerungen erfahren. Mittels nervenchirurgischer Konzepte konnten die Steuerungsmöglichkeiten vor allem für Patienten mit hohen Amputationen enorm verbessert werden. Technologische Weiterentwicklungen im Bereich der Mustererkennung ermöglichen mittlerweile die Steuerung multifunktionaler myoelektrischer Handprothesen in einer natürlichen und vor allem intuitiven Art und Weise. Der Stellenwert der oberen Extremität, im Speziellen der Hand, ist nach wie vor unumstritten und somit auch eine treibende Kraft in der technischen und chirurgischen Entwicklung des exoprothetischen Ersatzes. Die verschiedenen Amputationshöhen stellen das therapeutische Team allerdings vor unterschiedliche Herausforderungen. Nicht nur in Bezug auf die prothetische Anbindung, sondern auch auf das zu erwartende funktionelle Ergebnis der Prothesenrekonstruktion hat die Amputationshöhe entscheidenden Einfluss. In diesem Zusammenhang ist die Indikationsstellung zur prothetischen Versorgung vor allem bei Teilhandamputationen kritisch zu evaluieren, da für diese Patienten oftmals biologische chirurgisch-rekonstruktive Konzepte zielführender sind. In diesem Artikel werden die Möglichkeiten, aber auch Limitationen des exoprothetischen Extremitätenersatzes auf den verschiedenen Amputationsniveaus erläutert und das Anwendungsspektrum neuer Techniken dargestellt.

Abstract

During the last years, the prosthetic replacement in upper limb amputees has undergone different developments. The use of new nerve surgical concepts improved the control strategies tremendously, especially for high-level amputees. Technological innovation in the field of pattern recognition enables the control of multifunctional myoelectric hand prostheses in a natural and intuitive manner. However, the different levels of amputation pose different challenges for the therapeutic team which concern not only the prosthetic attachment; also the expected functional outcome of prosthetic limb replacement differs greatly between the individual levels of amputation. Therefore, especially in partial hand amputations the indication for prosthetic fitting has to be evaluated critically, as these patients may benefit more from biologic reconstructive concepts. The value of the upper extremity, in particular of the hand, is undisputable and, as such represents the driving force for the technological and surgical developments within the exoprosthetic replacement. This article discusses the possibilities and limitations of exoprosthetic limb replacement on the different amputation levels and explores new developments.

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