Improving the assessment and diagnosis of shoulder morbidity following mastectomy with breast reconstruction

改善乳房切除术后肩部发病率的评估和诊断

基本信息

批准号：
9912793
负责人：
David B Lipps
金额：
$ 14.89万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-10 至 2022-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912793
关键词：
Abdomen Address Adjuvant Radiotherapy Adoption Anatomy Assessment tool Autologous Breast Breast Cancer Patient Breast Cancer survivor Chest Chest wall structure Chronic Cosmetics Development Diagnosis Early Diagnosis Epigastric Evaluation Functional disorder Future Goals Image Implant Implantation procedure Inferior Intervention Investigation Joint structure of shoulder region Knowledge Late Effects Malignant Neoplasms Mammaplasty Mastectomy Measures Mechanics Medical center Methods Mission Morbidity - disease rate Muscle Musculoskeletal System Operative Surgical Procedures Outcome Outcome Measure Patient Outcomes Assessments Patients Perioperative Physiological Postoperative Care Postoperative Period Prevention Preventive Procedures Prognostic Marker Public Health Quality of life Radiation Radiation therapy Reconstructive Surgical Procedures Reporting Research Shoulder Shoulder Pain Sternum Surgical Flaps Surveys Technology Testing Therapeutic Therapeutic Intervention Tissue Expanders Tissues Ultrasonography Upper Extremity Variant Vertebral column Woman Work arm base cancer recurrence clinical practice cohort cost elastography follow-up functional outcomes functional status impaired driving performance improved innovation novel diagnostics operation pectoralis major muscle performance based measurement prospective psychosocial radiation effect reconstruction rehabilitation research rib bone structure standard of care

项目摘要

Mastectomy rates in the U.S. are increasing, driven by more breast cancer patients opting for a mastectomy with breast reconstruction. The cosmetic and psychosocial benefits to post-mastectomy breast reconstruction may come at a significant functional cost given the invasiveness of these procedures to the musculoskeletal system. It is critical that we understand the functional impact of different breast reconstruction approaches to help us enhance the availability of reconstruction surgeries within minimal functional impact and to better identify patients who will need therapeutic interventions as no standard of post-operative care currently exists. Our long term goal is to alleviate functional deficits following breast reconstruction by improving existing surgical approaches to lessen functional morbidity and enhancing the early detection of patients predisposed to shoulder morbidity. The overall objectives of this proposal is to begin addressing our goal by using ultrasound shear wave elastography (SWE) to identify reconstruction surgeries that significantly impact the pectoralis major, and by determining if these SWE measures can predict post-operative functional deficits. Our central hypothesis is that reconstructive procedures that require muscle disinsertion produce greater mechanical deficits of the pectoralis major and poorer upper extremity functional outcomes. The rationale for our proposed study is that it will allow us to identify the precursors of functional deficits in breast reconstruction patients. We will test our hypothesis by pursing two specific aims: 1) Determine how variations in surgical approaches to immediate or delayed breast reconstruction impact the mechanical integrity of the pectoralis major; and 2) Identify how post-operative mechanical changes to the pectoralis major relate to upper extremity functional status and quality of life. Under the first aim, breast cancer patients undergoing four different approaches to breast reconstruction will have the stiffness of the pectoralis major muscle prospectively evaluated with SWE. Under the second aim, these prospective evaluations of the pectoralis major will be associated with performance-based measures of upper extremity functional status and validated patient reported outcomes. The approach is innovative, in the applicant's opinion, because it presents a new and substantive method for evaluating post-operative function in patients following breast reconstruction, and is an important first step in validating this technology as a prognostic biomarker for future shoulder morbidity. The proposed research is significant, because it is expected to have broad translational importance for the prevention and treatment of shoulder morbidity in breast reconstruction patients. We expect these findings will immediately impacting clinical practice, including the adoption of surgical approaches with significantly reduced functional morbidity and bringing new focus to the for active surveillance in reconstruction patients whose procedures predispose them to functional morbidity. Ultimately, such knowledge has the potential to inform the development of a new standard of care for breast cancer patients in the U.S.

美国乳腺癌患者选择了乳腺癌切除术的乳腺癌患者的驱动术越来越高乳房重建。乳腺切除后乳房重建的化妆品和社会心理益处考虑到这些程序对肌肉骨骼的侵入性，可能会以显着的功能成本来系统。至关重要的是，我们了解不同乳房重建方法的功能影响帮助我们增强在最小功能影响中的重建手术的可用性，并更好地确定需要治疗干预措施的患者目前不存在术后护理标准。我们的长期目标是通过改善现有的乳房重建后减轻功能不足手术方法可降低功能发病率并提高患者的早期检测肩膀发病。该提案的总体目标是通过使用超声剪切波弹性图（SWE）确定重建手术，显着影响胸大肌主要，并确定这些SWE措施是否可以预测术后功能缺陷。我们的中心假设是需要肌肉消毒的重建程序会产生更大的胸大肌主要和较差的上肢功能结果的机械缺陷。理由我们提出的研究是，它将允许我们识别乳房重建中功能不足的前体患者。我们将通过追求两个具体目的来检验我们的假设：1）确定手术的变化如何立即或延迟乳房重建的方法会影响胸大肌的机械完整性主要的; 2）确定术后机械对胸大肌的变化与上肢有关功能状况和生活质量。在第一个目标下，乳腺癌患者接受了四种不同乳房重建方法将具有前瞻性胸大肌的刚度用SWE评估。在第二个目标下，这些对胸大学专业的前瞻性评估将是与上肢功能状态的基于绩效的措施和经过验证的患者有关报告的结果。申请人认为，这种方法具有创新性，因为它提出了新的和乳房重建后患者评估术后功能的实质性方法，是一种将这项技术验证为未来肩部发病率的预后生物标志物的重要第一步。这拟议的研究很重要，因为预计它对人具有广泛的翻译重要性乳房重建患者的肩部发病率的预防和治疗。我们希望这些发现会立即影响临床实践，包括采用外科手术方法显着降低功能性发病率并将新的重点引入重建患者的主动监视程序使它们易于功能发病率。最终，这种知识有可能告知为美国的乳腺癌患者开发新的护理标准

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Neuromuscular compensation strategies adopted at the shoulder following bilateral subpectoral implant breast reconstruction.

DOI：
10.1016/j.jbiomech.2021.110348
发表时间：
2021-05-07
期刊：
JOURNAL OF BIOMECHANICS
影响因子：
2.4
作者：
Leonardis, Joshua M.;Wolff, Whitney L.;Momoh, Adeyiza O.;Lipps, David B.
通讯作者：
Lipps, David B.

Age and sex influence the activation-dependent stiffness of the pectoralis major.

年龄和性别影响胸大肌的激活依赖性僵硬度。

DOI：
10.1111/joa.13455
发表时间：
2021
期刊：
Journal of anatomy
影响因子：
2.4
作者：
Setlock,CherylA;Lulic-Kuryllo,Tea;Leonardis,JoshuaM;Kulik,Madison;Lipps,DavidB
通讯作者：
Lipps,DavidB

Assessing shoulder muscle stretch reflexes following breast cancer treatment and postmastectomy breast reconstruction.

评估乳腺癌治疗和乳房切除术后乳房重建后的肩部肌肉牵张反射。