Diagnosing the Treating Elevated Joint Contact Stress to Avert Post-Traumatic OA

诊断和治疗关节接触应力升高以避免创伤后骨关节炎

基本信息

批准号：
8345678
负责人：
Donald D Anderson
金额：
$ 26.61万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8345678
关键词：
Acetabulum Fracture Acute Affect Aftercare Ankle Biological Markers Biological Markers Biology Biomechanics Caring Cartilage Clinical Clinical Research Complement Computer Simulation Decision Making Defect Degenerative polyarthritis Development Diagnosis Diagnostic Distal Elements External Fixation Devices Feasibility Studies Fracture Goals Hand Healed Health Image Injury Intervention Joints Knee Lead Lower Extremity Magnetic Resonance Imaging Measurement Measures Methodology Methods Modeling Morphology National Institute of Arthritis and Musculoskeletal and Skin Diseases Operating Rooms Operative Surgical Procedures Outcome Pain Patient Care Patients Postoperative Period Prevention Prospective Studies Research Residual state Retrospective Studies Risk Risk Factors Role Series Serum Simulate Site Staging Stress Structure Surface Surgeon Techniques Testing Thick Time Urine Work X-Ray Computed Tomography base bone calcaneum conventional therapy distraction follow-up healing improved innovation insight joint injury joint stress novel novel therapeutic intervention novel therapeutics operation patient population prevent tibia tool

项目摘要

Elevated joint contact stress from residual articular incongruity following intra-articular fracture (IAF) is a critically important risk factor for post-traumatic OA (PTOA) that until recently could not be assessed, presenting a major obstacle to meaningful research aimed at improving treatment. The goals of the proposed research are to employ a clinically applicable measure of contact stress, obtained using computational discrete element analysis (DEA) methods, to diagnose patients at risk of PTOA following IAF and to develop and test methods of preventing elevated contact stress from joint incongruity. In retrospective studies of different lower extremity joints, DEA will be utilized to identify thresholds of joint contact stress above which PTOA is most highly likely (Specific Aim 1). To advance understanding of how elevated cumulative contact stress after IAF affects joint structure and biology to cause PTOA, prospective studies will be undertaken to correlate contact stress levels with morphologic articular surface changes detected on MRI, with alterations in serum and urine biomarkers, with radiographic changes, and with patient pain and function (Aim 2). The other two aims of this study will make important clinical steps to prevent elevated contact stress following IAF and thereby improve patient outcomes. New intra-operative techniques will be developed to assess the contact stress exposure associated with a given candidate IAF reduction during operations, to inform surgeons in their decision-making. These novel techniques will be based on deduced fragment poses from fluoroscopic images correlated with pre-operative CT models; contact stress estimates will be calculated with DEA. These techniques will be assessed on simulated fracture models and piloted in the operating room during IAF surgery and compared with conventional treatment (Aim 3). In a pilot clinical feasibility study, acute joint distraction using a ring fixator for severe tibial pilon fractures will be assessed using DEA, MRI and biomarkers to determine if temporarily sparing damaged articular surfaces from harmful joint contact stress after injury improves joint healing in such high energy IAFs (Aim 4).

关节内断裂（IAF）后残留关节不一致的关节接触应力升高是创伤后OA（PTOA）至关重要的危险因素，直到最近才无法评估，这是有意义的研究的主要障碍，旨在改善治疗。拟议的研究的目标是采用使用计算离散元素分析（DEA）方法获得的临床适用的接触应力度量，以诊断IAF后PTOA风险的患者，并开发和测试和测试方法，以防止关节不一致的接触应力升高。在对不同下肢关节的回顾性研究中，将利用DEA来确定PTOA极有可能极有可能的关节接触应力阈值（特定目标1）。为了促进IAF后累积接触应力升高影响关节结构和生物学引起PTOA的累积接触应力，将进行前瞻性研究，以将接触应力水平与MRI上检测到的形态关节表面变化相关联，以及血清和尿液生物标志物的变化，放射线学变化，以及患者疼痛和功能（AIM 2）。这项研究的其他两个目标将做出重要的临床步骤，以防止IAF后IAF的接触压力升高，从而改善患者的结局。将开发新的术中技术，以评估与给定候选者IAF在手术过程中相关的接触应力暴露，以告知外科医生的决策。这些新型技术将基于与术前CT模型相关的荧光镜图像的推导片段姿势。接触应力估计将通过DEA计算。这些技术将在模拟的断裂模型上评估，并在IAF手术期间在手术室进行试验，并与常规治疗进行比较（AIM 3）。在一项试点临床可行性研究中，将使用DEA，MRI和生物标志物评估使用环固定器进行严重胫骨pilon骨折的急性关节分散注意力，以确定在这种高能量IAFS中，损伤后有害关节接触应力是否暂时保留有害关节接触应力受损的关节接触应力（AIM AIM 4）。