Local Biomechanics of Median Nerve Insult in Carpal Tunnel Syndrome

腕管综合征正中神经损伤的局部生物力学

• 批准号: 7372803
• 负责人: THOMAS DUDLEY BROWN
• 金额: $ 27.12万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-07 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7372803
• 关键词: Address; Adopted; Affect; Anatomic structures; Anatomy; Area; Biomechanics; Carpal Tunnel Syndrome; Cataloging; Catalogs; Chronic; Clinical; Complex; Condition; Control Groups; Disease; Distal; Drug Formulations; Elements; Exercise; Family; Finite Element Analysis; Flexor; Functional disorder; Future; Goals; Hand; Image; Immersion Investigative Technique; Incidence; Individual; Isometric Exercise; Kinetics; Ligaments; Link; Liquid substance; Logistics; Magnetic Resonance Imaging; Measurement; Measures; Mechanical Stress; Mechanics; Modeling; Molecular; Motion; Musculoskeletal; Musculoskeletal Diseases; Nerve; Operative Surgical Procedures; Output; Pathway interactions; Patients; Peripheral; Peripheral Nerves; Personal Satisfaction; Predisposition; Purpose; Regression Analysis; Relative (related person); Research; Research Personnel; Rest; Series; Severities; Solid; Stress; Symptoms; Tendon structure; Testing; Work; base; bone; digital; improved; interdisciplinary approach; kinematics; median nerve; member; novel; pressure; response

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is among the most important of the family of musculoskeletal disorders caused by chronic peripheral nerve compression. Generically, mechanical insult to the median nerve is well recognized as the proximate cause. However, despite the existing large body of research in many disciplinary areas, objective characterization of the local biomechanical insult directly responsible for the disorder remains conspicuously absent. The central paradigm of the proposed research is that local mechanical stress on the median nerve can be meaningfully quantified. This mechanical stress is due to fluid pressure within the confines of the tunnel, and direct physical contact of the median nerve with adjacent anatomic structures. Both of these types of interactions can be quantified - in tandem - by finite element (FE) analysis, using an anatomically based, three-dimensional, fluid immersion multi-body contact formulation, which has been developed in preliminary work. The long-term goal of the study is to establish an objective mechanistic framework for linking CTS with quantifiable biomechanical influence factors. An interdisciplinary approach will be adopted, integrating research team member expertise in the areas of biomechanical stress analysis, hand surgery, and musculoskeletal magnetic resonance imaging (MRI). The project has three specific aims: (1) Refine and physically validate the numerical model, and use it to explore the relative importance of fluid pressure versus solid contact on median nerve stress in normal subjects and CTS patients. (2) Based on clinical measurement, systematically study the effects of individual anatomic and functional parameters on median nerve stresses, and perform logistic regression analysis to identify the most important influence factor(s) or group(s) of factors. (3) Test for association between FE-identified factors most predisposing to elevated median nerve mechanical stress, and the presence and severity of CTS symptoms, in an affected patient group and in a negative control group of matched normal subjects.

描述（由申请人提供）：腕管综合征（CTS）是由慢性周围神经压缩引起的肌肉骨骼疾病家族中最重要的。从一般而言，机械侮辱中位神经被广泛认为是近端原因。但是，尽管在许多纪律领域进行了大量研究，但直接负责该疾病的局部生物力学侮辱的客观表征仍然显着。拟议的研究的中心范式是，可以有意义地量化中位神经的局部机械应力。这种机械应力是由于隧道范围内的流体压力以及中位神经与相邻解剖结构的直接物理接触所致。这两种类型的相互作用都可以通过有限元（Fe）分析来量化，并使用基于解剖学的三维流体浸入多体型接触公式，这是在初步工作中开发的。该研究的长期目标是建立一个客观的机械框架，以将CT与可量化的生物力学影响因素联系起来。将采用一种跨学科方法，将研究团队成员专业知识整合在生物力学压力分析，手术和肌肉骨骼磁共振成像（MRI）领域。该项目具有三个特定的目的：（1）细化并物理验证数值模型，并使用它来探索流体压力与固体接触对正常受试者和CTS患者中位神经应激的相对重要性。 （2）基于临床测量，系统地研究单个解剖和功能参数对中位神经应力的影响，并执行逻辑回归分析以识别最重要的影响因子（S）或因素组。 （3）在受影响的患者组中，在匹配的正常受试者的负面对照组中，在较高的中位神经机械应力和CTS症状的存在和严重程度的存在和严重程度之间进行了相关性测试。