The Dynamic Glenoid Track: An Updated Model of Glenohumeral Cartilage Contact During In Vivo Movement

动态关节盂轨迹：体内运动期间盂肱软骨接触的更新模型

• 批准号: 10375039
• 负责人: William J. Anderst
• 金额: $ 104.15万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-25 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375039
• 关键词: Affect; Anatomy; Ancillary Study; Anterior; Biomechanics; Cadaver; Cartilage; Data; Decision Making; Diagnostic radiologic examination; Evaluation; Guidelines; Head; Image; Individual; Injury; Lead; Lesion; Location; Magnetic Resonance Imaging; Measures; Modeling; Morphology; Movement; Muscle; Operative Surgical Procedures; Parents; Patients; Physiological; Procedures; Process; Recurrence; Reporting; Rotation; Shoulder; Specimen; Surgeon; Testing; Time; Tissues; Unemployment; Update; Width; base; bone; bone loss; cohort; improved; in vivo; injured; insight; kinematics; optimal treatments; predictive modeling; restoration; shoulder injury; tool

Project Summary/Abstract Anterior shoulder instability is a common problem in physically active individuals and has serious long-term implications due to the high rate of injury recurrence and the resulting extended time out of work. The injury leading to anterior instability often includes damage to both the humeral head (Hill-Sachs lesion) and glenoid bone (bony Bankart lesion). The current surgical guidelines for treating anterior instability in the presence of bony lesions are based upon biomechanical studies that measured glenohumeral contact regions (the “glenoid track”) in cadaver specimens during static simulated loading. Cadaver-based biomechanical studies cannot replicate in vivo loads, kinematics, and muscle activity, and so the current guidelines lack the accuracy and generalizability needed to guide surgical decision-making in patients with anterior shoulder instability and subcritical (10% to 20%) glenoid bone loss. A critical need exists to improve our understanding of how anatomy and kinematics affect glenohumeral articular contact during in vivo movement so that the optimal surgical treatment can be identified in this challenging patient cohort. The objectives of this study are to define the dynamic glenoid track and to develop and validate a patient-specific evaluation process, based upon the dynamic glenoid track, to predict shoulder function after three common surgeries to treat anterior shoulder instability. In this mechanistic ancillary study, in vivo kinematics from dynamic biplane radiography (DBR) will be combined with cartilage morphology from MRI to measure glenohumeral contact regions during loaded and unloaded circumduction and during external rotation at 30°, 60°, 90° and 120° of abduction (the dynamic glenoid track). The dynamic glenoid track will be measured in healthy controls and compared to the previously reported static glenoid track. Data from healthy shoulders will then be used to develop a model to predict cartilage contact and instability in patients based upon bone lesion size and location. The validity and robustness of the model will be evaluated by testing patients from the parent study prior to surgery. Finally, the ability of the patient-specific models to predict cartilage contact regions after surgery will be evaluated using pre and post-surgery data from patients in the parent study. The Specific aims are: 1) to compare the in vivo dynamic glenoid track in healthy shoulders to the previously reported static glenoid track, 2) to develop and validate a patient-specific evaluation process for predicting glenohumeral cartilage contact during dynamic in vivo movement, and 3) to determine the accuracy of the patient-specific model in predicting dynamic glenohumeral cartilage contact after surgery. Achieving these objectives will provide insight into the anatomic and kinematic mechanisms that lead to the loss and restoration of anterior shoulder stability, and will clarify and improve the surgical guidelines for patients with anterior shoulder instability and subcritical glenoid bone loss.

项目摘要/摘要 前肩不稳定性是身体活跃的人的常见问题，长期存在严重 由于损伤复发率高以及延长工作的含义。受伤 导致前部不稳定通常包括对肱骨头（山丘病变）和关节盂的损害 骨头（骨bankart病变）。目前的手术指南在存在下治疗前不稳定 骨质病变基于测量藻类接触区域的生物力学研究 曲目”）在静态模拟加载过程中的尸体标本中。基于尸体的生物力学研究不能 复制体内负荷，运动学和肌肉活动，因此当前的准则缺乏准确性和 指导前肩不稳定患者的手术决策所需的概括性和 亚临界值（10％至20％）盂骨流失。存在批判性需求，以提高我们对如何的理解 解剖学和运动学会影响体内运动过程中的藻脉关节接触 可以在此挑战患者队列中确定手术治疗。这项研究的目标是定义 动态关节类轨道并根据 动态性斜线轨道，以预测三个常见手术后的肩部功能以治疗前肩 不稳定。在这项机械辅助研究中，来自动态双翼射线照相（DBR）的体内运动学 与MRI的软骨形态结合到负载期间测量藻瘤接触区域 卸载的周围和外部旋转期间在30°，60°，90°和120°的外展（动态 关节盂轨道）。动态盂轨将在健康对照中测量，并与以前的 报告的静态关节藻轨道。然后，来自健康肩膀的数据将用于开发模型以预测 根据骨骼病变的大小和位置，患者的软骨接触和不稳定。有效性和 该模型的鲁棒性将通过在手术前对父母研究的患者进行测试来评估。最后， 将使用患者特异性模型预测手术后软骨接触区域的能力 父母研究中患者的术前和手术后数据。具体目的是：1）比较体内 健康肩部中的动态盂轨轨道，直到先前报道 验证特定于患者的评估过程，以预测动态期间的藻软骨接触 体内运动和3）确定患者特异性模型在预测动态方面的准确性 手术后的Glenohumeral软骨接触。实现这些目标将为解剖学提供洞察力 和运动机制，导致前肩稳定的损失和恢复，并将澄清 并改善了前肩部不稳定和亚临界骨骨的患者的手术指南 损失。