Quantifying Fracture Severity Using a 3-D Puzzle Solving Approach

使用 3-D 解谜方法量化骨折严重程度

• 批准号: 7529183
• 负责人: Donald D Anderson
• 金额: $ 20.15万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7529183
• 关键词: 3-Dimensional; Accounting; Acute; Ankle; Arthritis; Biomedical Engineering; Clinical; Comminuted Fracture type; Complication; Computational algorithm; Data; Degenerative polyarthritis; Development; Diabetes Mellitus; Disease; Etiology; Evaluation; Fracture; Goals; Gold; Health; Heart Diseases; Incidence; Individual; Injury; Intervention; Invasive; Investigation; Joints; Knee; Knowledge; Lasers; Limb structure; Measurement; Measures; Mechanics; Methods; Metric; Morbidity - disease rate; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Patients; Pattern; Positioning Attribute; Public Health; Research; Research Project Grants; Risk; Scanning; Series; Severities; Solutions; Specimen; Standards of Weights and Measures; Stroke; Surface; Surgeon; Techniques; Technology; Testing; Tissues; Trauma; Traumatic Arthropathy; Well in self; Work; X-Ray Computed Tomography; base; bone; cohort; disability; experience; functional outcomes; impression; indexing; innovation; novel; outcome forecast; prevent; research clinical testing; response; soft tissue; translational study; wound

DESCRIPTION (provided by applicant): The proposed research aims to advance innovative methods for the evaluation of patients who have sustained comminuted intra-articular fractures. The risk of post-traumatic osteoarthritis (PTOA), a late complication with substantial lifelong morbidity and disability, is related to the intensity of the joint trauma accompanying these fractures. Current methods for assessing the severity of joint injury are limited, irreproducible, and generally qualitative, hindering the evaluation of new treatments aimed at avoiding PTOA. Until the severity of the initial injury can be objectively measured, it will remain a substantial confounder hindering meaningful investigation. A global objective of the proposed work is to establish physically-grounded, non-invasive techniques to quantify intra-articular fracture severity. CT-derived measures of the mechanical energy expended in a given fracture provide an index of the mechanical insult to the joint. They do not account for localization of fragmentation, or fragment displacement and dispersal, critical factors reflecting the risk of PTOA, as this requires presently unavailable knowledge of the positions that the dispersed fragments originally occupied in the intact bone. Deducing this information entails, in effect, solving a three-dimensional (3-D) puzzle, a task for which suitable computational algorithms have recently begun to emerge. This new capability holds the potential to greatly advance the manner in which comminuted intra-articular fractures are assessed, facilitating investigation of new treatments (primarily biologic) aimed at restoring the health of at-risk articular tissues. Two specific aims will be pursued to advance 3-D puzzle solving methods for this use. Specific Aim 1 is to generate representative fracture fragmentation in test specimens machined from a bone surrogate material, and encased in a soft tissue surrogate. Fragment volumetric and surface data will be obtained from CT scans (intended clinical use), with fragments in their spontaneously-displaced/interspersed positions, and duplicate surface data will be obtained from ensuing laser scans of individual fragments (gold standard). Working from these data, the accuracy of fracture fragment segmentation, and 3-D puzzle solution accuracy in reconstructing the known pre- fracture specimen geometry, will be determined. Specific Aim 2 is to obtain 3-D puzzle solutions, and associated fracture severity indices, working from an existing series of tibial plafond fracture cases for which three to five year outcome data will be available. Fracture severity metrics will be correlated with a clinical rank ordering of severity, and in turn with the clinical incidence of PTOA, and with functional outcome measures. PUBLIC HEALTH RELEVANCE: Patients sustaining severe limb trauma in which bones are highly fragmented and the fracture extends into an articular joint such as the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling outcome. Lacking objective measures of fracture severity, surgeons presently rely upon subjective impressions to guide treatment of these patients, hindering progress toward forestalling post-traumatic arthritis. A 3-D puzzle solving approach yields new, objective measures of articular fracture severity, providing a novel framework for statistically robust clinical/translational studies of new treatments to reduce the risk of post-traumatic arthritis.

描述（由申请人提供）：拟议的研究旨在提高创新方法，以评估持续关联关节内骨折的患者。创伤后骨关节炎（PTOA）的风险是终生发病率和残疾的晚期并发症，与伴随着这些骨折的关节创伤的强度有关。当前评估关节损伤严重程度的方法有限，不可重复且通常是定性的，阻碍了旨在避免PTOA的新疗法的评估。直到可以客观地衡量最初伤害的严重程度之前，它将仍然是一种妨碍有意义调查的巨大混杂因素。拟议的工作的全球目标是建立具有物理基础的非侵入性技术来量化关节内断裂严重程度。在给定断裂中消耗的机械能的CT衍生测量值为关节提供了机械侮辱的指数。它们不解释碎裂的定位，或碎片位移和分散的关键因素，反映了PTOA的风险，因为这需要目前无法获得最初在完整骨中占据的分散碎片的位置的知识。实际上，推论这些信息需要解决三维（3-D）拼图，该任务最近开始出现合适的计算算法。这种新能力有可能大大提高评估关节内骨折的方式，从而促进对旨在恢复处于危险关节组织健康的新疗法（主要是生物学）的研究。将追求两个具体的目标，以推进此用途的3D拼图解决方法。具体目的1是在从骨替代物质加工的测试标本中产生代表性的断裂碎片，并包裹在软组织替代物中。将从CT扫描（预期的临床用途）获得片段的体积和表面数据，其自发放置/散布的位置的片段将获得片段，并且将通过随之而来的单个碎片的激光扫描（金标准）获得重复的表面数据。从这些数据中工作，将确定重建已知的骨折标本几何形状的断裂片段分割的精度和3-D拼图解决方案的精度。具体目的2是获得3-D拼图解决方案和相关的断裂严重程度指数，该指数是通过现有的一系列胫骨Plafond断裂病例来工作的，可以为其提供三到五年的结果数据。断裂严重程度指标将与严重程度的临床等级排序相关，而PTOA的临床发生率也将与功能结果指标相关。 公共卫生相关性：骨骼高度分散的严重肢体创伤的患者，骨折延伸到关节关节，例如踝关节或膝盖，通常预后较差，最终作为常见的关节炎是一种常见的残疾结果。由于缺乏骨折严重程度的客观度量，外科医生目前依靠主观印象来指导这些患者的治疗，阻碍了阻止创伤后关节炎的进展。 3-D拼图解决方法产生了关节断裂严重程度的新的客观测量，为新疗法的统计坚固临床/翻译研究提供了新的框架，以降低创伤后关节炎的风险。