Quantifying Injury Severity to Assess the Risk of Post-Traumatic Osteoarthritis

量化损伤严重程度以评估创伤后骨关节炎的风险

• 批准号: 7920169
• 负责人: J LAWRENCE MARSH
• 金额: $ 20.97万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7920169
• 关键词: Ankle; Arthritis; Biological Assay; Biological Markers; Biological Process; Cartilage; Clinical; Collagen; Complication; Computers; Data; Degenerative polyarthritis; Development; Etiology; Fracture; Healed; Inflammation; Injury; Institution; Intervention; Investigation; Joints; Knee; Link; Measurable; Measures; Mechanics; Methodology; Methods; Metric; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Patients; Physical assessment; Pilot Projects; Prospective Studies; Proteoglycan; Public Health; Recovery; Research; Risk; Scientific Evaluation; Series; Severities; Soft Tissue Injuries; Surface; Surgeon; Synovial Fluid; Techniques; Technology; Texture; Time; Work; base; bone; cohort; design; disability; experience; healing; indexing; inflammatory marker; injured; joint injury; novel; novel strategies; outcome forecast; prospective; translational study

PROJECT SUMMARY: The proposed research aims to convincingly establish new physically-grounded non- invasive techniques to quantify the severity of intra-articular fractures. Post-traumatic osteoarthritis (PTOA) is a frequent and often early complication of treatment, with substantial lifelong morbidity and disability. The intensity of the initial joint trauma in intra-articular fractures is a critically important factor in the etiology of PTOA. Interventions to surgically reduce the displaced and fragmented articular surface have been developed and refined over decades. Yet, for some injuries, PTOA remains seemingly inevitable, with surgical advances unlikely to appreciably change the prognosis. Little is known regarding the biological processes at work within the joint shortly following these injuries, or how they link joint injury to eventual PTOA. Newly proposed biologic interventions warrant further scientific evaluation, but this will require that patient cohorts be reasonably stratified and studied in large enough numbers to yield statistically robust findings. To stratify patients, the severity of the initial injury must be objectively measured, lest it remain a substantial confounder that will continue to preclude meaningful investigation. We have developed and validated enabling technology to measure fracture severity in a clinical setting. AIM 1: We will extend and expedite this CT-based methodology to better assess articular fractures, implementing new techniques to assess articular fragmentation, fragment dispersal, and the soft tissue injury. AIM 2: In a prospective multi- center study we will correlate the expedited injury severity metric with a new computer-based method to continually rank order cases for severity, and we will correlate both of these severity metrics with the development of PTOA. AIM 3: We will assay synovial fluid from injured ankles in a prospective study of tibial plafond fracture patients, to gather descriptive data regarding joint damage and recovery in the early post- injury period. These biologic markers will be correlated with the expedited injury severity metric, and each in turn will be correlated with patient outcomes. RELEVANCE TO PUBLIC HEALTH: Patients who sustain fractures that extend into an articular joint, such as the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling result. Surgeons rely upon subjective empirical experience to guide articular fracture treatment, and this greatly hinders progress. This study will provide fundamentally new objective non-invasive methods to measure articular fracture injury severity. These methods will have important clinical implications in their own right, and provide a novel framework for statistically robust clinical/translational studies to reduce the risk of PTOA.

项目摘要：拟议的研究旨在令人信服地建立新的物理基础的非 - 侵入性技术来量化关节内骨折的严重程度。创伤后骨关节炎（PTOA）为 经常出现的治疗并发症，具有终生的发病率和残疾。这 关节内骨折中初始关节创伤的强度是病因的至关重要因素 PTOA。通过手术减少移位和碎片的关节表面的干预措施已经 数十年来开发和完善。然而，对于某些伤害，PTOA似乎仍然是不可避免的， 手术进展不太可能明显改变预后。关于生物学知之甚少 在这些伤害后不久的关节内工作的过程，或它们如何将关节伤害与最终联系起来 PTOA。新提出的生物学干预措施需要进一步的科学评估，但这将要求 患者队列进行合理分层并进行大量研究以产生统计上的稳定性 发现。要对患者进行分层，必须客观地测量初始损伤的严重程度，以免它仍然是 实质性的混杂因素将继续排除有意义的调查。我们已经开发了 验证了使技术在临床环境中测量断裂严重程度。目标1：我们将扩展并 加快这种基于CT的方法来更好地评估关节骨折，实施新技术 评估关节碎片，碎片分散和软组织损伤。目标2：在潜在的多 中心研究我们将将加急伤害严重性指标与一种新的基于计算机的方法相关联 持续对严重程度的订单案例进行排序，我们将将这两个严重性指标与 PTOA的开发。 AIM 3：我们将在胫骨前瞻性研究中测定受伤脚踝受伤的滑液 Plafond骨折患者，以收集有关关节损伤和恢复的描述性数据 - 受伤期。这些生物标记将与加急伤害严重性指标相关，并且在 转弯将与患者结局相关。 与公共卫生有关：维持裂缝延伸到关节关节的患者 作为脚踝或膝盖，预后通常较差，最终关节炎是常见的残疾结果。 外科医生依靠主观的经验经验来指导关节骨折治疗，这很大程度上 阻碍进步。这项研究将提供从根本上提供新的客观非侵入性方法来衡量 关节断裂损伤严重程度。这些方法本身将具有重要的临床意义 并为统计上强大的临床/翻译研究提供了一个新颖的框架，以降低 PTOA。