Changes in proximal tibia fracture strength as a function of time elapsed since s

近端胫骨骨折强度的变化作为自 s 以来经过的时间的函数

• 批准号: 8200836
• 负责人: William Brent Edwards
• 金额: $ 5.13万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8200836
• 关键词: Accounting; Affect; Agreement; Anatomy; Biological Models; Biomechanics; Bone Density; Bone Development; Chronic; Clinical; Complex; Cross-Sectional Studies; Data; Development; Distal; Elderly woman; Elements; Epidemiology; Event; Exercise; Failure; Femoral Fractures; Femur; Fracture; General Population; Goals; Hospitalization; Human; In Vitro; Incidence; Individual; Injury; Intervention; Lead; Lesion; Life; Location; Lower Extremity Fracture; Measurement; Measures; Methods; Minor; Modeling; Morbidity - disease rate; Motor; Neurologic; Population; Predictive Value; Quality of life; Radial; Regression Analysis; Research; Research Design; Risk; Risk Assessment; Scientist; Source; Specimen; Spinal cord injury; Statistical Models; Structure; Techniques; Tibial Fractures; Time; Trauma; Work; X-Ray Computed Tomography; active method; age related; base; bone; bone disuse atrophy; bone loss; bone mass; bone strength; density; experience; improved; in vivo; innovation; lifetime risk; medical complication; research study; skeletal; substantia spongiosa; tibia; tool

DESCRIPTION (provided by applicant): Spinal cord injury (SCI) is characterized by marked bone loss at regions below the neurological lesion. The clinical consequence of this reduction in bone is an increased lifetime risk for lower-extremity fracture due to minor trauma that is two times greater than the general population. Fracture risk assessment tools for the general public are inadequate for people living with SCI; the locations of routine fracture do not correspond between these two groups and bone density thresholds defining elevated fracture risk are typical of individuals with SCI. The ability to accurately quantify fracture strength in people with SCI could serve as an important clinical tool to assess fracture risk and objectively identify individuals that could safely participate in active treatment. The objectives of this application are to: Aim 1) develop a numerical method based on quantitative computed tomography (CT) capable of predicting fracture strength at the proximal tibia (a location commonly fractured following SCI), and Aim 2) quantify the change in fracture strength that occurs as a function of time elapsed since SCI. Aim 1 will be accomplished using a combined numerical-experimental study. Cadaveric proximal tibiae will be mechanically loaded until failure. Specimen-specific finite element models will be derived from CT data, and their ability to predict fracture strength determined from a regression analysis of numerical and experimental fracture loads. The predictive value of the finite element models will be compared to statistical models based on CT derived measures of bone mass, density, and structure. Aim 2 will be accomplished using a cross-sectional study design in which the fracture strength of individuals with motor complete SCI, as well as able-bodied controls, will be estimated from CT data. Reductions in fracture strength and bone parameters as a function of time since SCI will be quantified. The long-term goal of this research is to increase the quality of life for people living with SCI by minimizing the incidence of bone fracture in this population. This study will bring biomechanical relevance to the observed bone adaptive changes following SCI and help delineate the most critical determinants of bone fracture strength in this population. This will provide important information that can be used to help guide pharmacologic and exercise interventions that target adaptive changes in parameters most relevant to whole-bone fracture strength. In addition, because the SCI population serves as a model system for disuse osteoporosis, this work will increase our understanding of skeletal fracture in other populations having chronic bone loss and help guide the development of bone strengthening interventions for these individuals. PUBLIC HEALTH RELEVANCE: We propose to 1) develop new methods to quantify whole-bone fracture strength in people living with spinal cord injury, and 2) determine the changes in fracture strength that occur as a function of time elapsed since spinal cord injury. This work will increase our understanding of skeletal fracture in people having chronic bone loss and will facilitate the development of countermeasures to minimize the occurrence of skeletal fracture in this population.

描述（由申请人提供）：脊髓损伤（SCI）的特征是神经病病变以下区域的骨质流失明显。骨骼减少的临床后果是由于轻微的创伤而导致的终身风险增加了，这是一般人群的两倍。公众的破裂风险评估工具不足以使SCI患者不足；常规断裂的位置在这两组和定义升高风险升高的骨密度阈值之间并不对应于SCI的个体。精确量化SCI患者断裂强度的能力可以作为评估断裂风险并客观地识别可以安全参与积极治疗的个人的重要临床工具。该应用程序的目标是：目标1）基于定量计算机断层扫描（CT）的数值方法，能够预测胫骨近端处的断裂强度（SCI后通常骨折的位置），而目标2）量化骨折强度的变化，这些变化是自SCI自SCI以来就具有时间功能的分裂强度的变化。 AIM 1将使用合并的数值实验研究来完成。尸体近端胫骨将被机械加载，直到失败为止。标本特异性的有限元模型将从CT数据中得出，并从数值和实验性断裂负荷的回归分析中预测断裂强度的能力。有限元模型的预测值将与基于CT得出的骨骼质量，密度和结构的统计模型进行比较。 AIM 2将使用横截面研究设计来完成，其中将根据CT数据估算具有运动完整SCI的个体的断裂强度以及健全的控件。由于SCI将被量化，因此断裂强度和骨骼参数的降低随时间的函数。这项研究的长期目标是通过最大程度地减少该人群中骨折的发生率来提高患有SCI的人的生活质量。这项研究将使SCI后观察到的骨骼适应性变化具有生物力学相关性，并有助于描绘该人群中骨断裂强度的最关键决定因素。这将提供重要信息，可用于指导药物和运动干预措施，以针对与全骨断裂强度最相关的参数的适应性变化。此外，由于SCI人群是废除骨质疏松症的模型系统，因此这项工作将增加我们对具有慢性骨质流失的其他人群中骨骼断裂的理解，并有助于指导这些人的骨骼加强干预措施的发展。 公共卫生相关性：我们建议1）开发新方法来量化脊髓损伤患者的全骨骨折强度，2）确定自脊髓损伤以来经过的时间的函数发生的断裂强度的变化。这项工作将增加我们对患有慢性骨质损失的人的骨骼断裂的理解，并促进对策的发展，以最大程度地减少该人群中骨骼骨折的发生。