Characterizing dynamic thumb metacarpal subsidence during functional tasks after trapeziectomy

梯形切除术后功能任务期间动态拇指掌骨下沉的特征

• 批准号: 10676865
• 负责人: William J. Anderst
• 金额: $ 17.49万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676865
• 关键词: 3-Dimensional; Affect; Biomedical Research; Carpometacarpal joint structure; Clinical; Clinical Research; Clinical Trials; Data; Degenerative polyarthritis; Evaluation; Excision; Exertion; Exploratory/Developmental Grant; Future; Human; Image; Joint repair; Joints; Knowledge; Ligaments; Measurement; Measures; Metacarpal bone; Methods; Modeling; Modification; Operative Surgical Procedures; Patients; Procedures; Protocols documentation; Reconstructive Surgical Procedures; Reproducibility; Site; Surgical sutures; Techniques; Tendon structure; Three-Dimensional Imaging; Thumb structure; Upper Extremity; bone; clinical imaging; design; digital; grasp; improved; in vivo; kinematics; migration; novel; novel strategies; prevent; radiological imaging; reconstruction; research clinical testing; research study; secondary analysis; soft tissue; standard of care; trapezium

Project Summary/Abstract: The thumb carpometacarpal (CMC) joint is the second most common site of osteoarthritis (OA) in humans and the most common site of surgical reconstruction for OA in the upper extremity. The current standard of care includes removal of the trapezium followed by soft tissue modifications to prevent loss of strength due to proximal migration of the thumb after surgery (subsidence). The evidence demonstrating that strength loss after trapeziectomy is related to thumb metacarpal subsidence is inconclusive, so the need for these additional procedures remains controversial. The primary objectives of this study are to clarify the relationship between thumb metacarpal subsidence and thumb strength, and to develop and validate a new imaging protocol that can accurately estimate dynamic 3D thumb metacarpal subsidence using 2D radiographs. Achieving these objectives will improve future biomedical research and clinical evaluation of patients after trapeziectomy and may lead to a more effective surgical procedure for restoring strength after trapeziectomy. This study will include 50 patients who received trapeziectomy followed by either LRTI or suspensionplasty within the past 6 to 12 months. We will use dynamic biplane radiography to measure 3D thumb metacarpal kinematics while simultaneously measuring thumb force during pinching, grasping and jar opening. Next, we will use 3D imaging data from the first 30 patients to develop a new imaging protocol to estimate dynamic thumb metacarpal subsidence using 2D radiographs. The new protocol will then be validated on the remaining 20 patients. The first Specific Aim is to determine the relationship between thumb metacarpal subsidence and thumb strength. Achieving this Aim will address the gap in our knowledge as to how thumb subsidence affects strength after trapeziectomy. This advance in understanding how kinematics are related to strength can be used to improve surgical procedures that involve trapeziectomy. The second Specific Aim is to develop and validate a new clinical imaging protocol to accurately estimate dynamic thumb metacarpal subsidence after trapeziectomy. In this Aim, we will generate simulated radiographs from patient-specific bones and their pose to identify the optimal imaging configuration for measuring thumb metacarpal subsidence. This will overcome the hurdle that exists for accurately evaluating thumb metacarpal subsidence using clinical radiographs and it will lead to improved biomedical and clinical research related to measuring thumb subsidence after trapeziectomy. The results of this study may be used to inform the design of a better surgical procedure for patients with CMC OA, to improve clinical evaluation of subsidence after trapeziectomy, and to enable large-scale clinical trials involving patients after trapeziectomy. This study will be the first to combine biplane radiography and force measurement to characterize dynamic thumb kinematics and loading in vivo during functional tasks and it proposes a novel approach to use digitally reconstructed radiographs to identify the optimal radiographic imaging configuration for clinical evaluation.

项目摘要/摘要：拇指腕足（CMC）关节是第二大最常见的位置 人类的骨关节炎（OA）和上部OA的最常见手术重建部位 末端。当前的护理标准包括去除梯形，然后进行软组织修饰 为了防止由于手术后拇指近端迁移而导致的强度损失（沉降）。证据 证明梯年切除术后的强度损失与拇指元帕帕的沉降有关，尚无定论 因此，对这些其他程序的需求仍然存在争议。这项研究的主要目标是 阐明拇指元帕帕尔的沉降与拇指强度之间的关系，并发展和验证 一种新的成像协议，可以使用2D准确估算动态3D拇指元帕帕尔沉积 X光片。实现这些目标将改善未来的生物医学研究和临床评估 梯曲切除术后的患者，可能会导致更有效的手术程序，以恢复强度 梯形切除术。这项研究将包括50名接受梯级切除术的患者，然后是LRTI或 在过去的6到12个月内悬挂式置换术。我们将使用动态双翼片来测量3D 拇指掌pal运动学同时测量捏，握和罐子期间的拇指力 开场。接下来，我们将使用前30名患者的3D成像数据来开发新的成像协议 使用2D X光片估计动态拇指元帕尔巴pal沉降。然后将验证新协议 在其余20名患者上。第一个具体目的是确定拇指元掌之间的关系 沉降和拇指力量。实现这一目标将解决我们知识的差距 沉降会影响梯性切除术后的力量。这是了解运动学与 强度可用于改善涉及梯形切除术的手术程序。第二个具体目的是 开发和验证一种新的临床成像协议，以准确估计动态拇指元掌pal 梯曲切除术后的沉降。在此目标中，我们将从患者特异性的 骨骼及其姿势以识别用于测量拇指元掌的最佳成像构型 沉降。这将克服用于准确评估拇指元玛泊沉降的存在的障碍 使用临床X光片，它将导致改善与测量有关的生物医学和临床研究 梯形切除术后的拇指沉降。这项研究的结果可用于告知设计更好的设计 针对CMC OA患者的手术程序，以改善梯性切除术后沉降的临床评估， 并能够在梯性切除术后涉及患者的大规模临床试验。这项研究将是第一个 结合双翼片和力测量，以表征动态拇指运动学并加载 在功能任务期间的体内，它提出了一种新颖的方法，将使用数字重建的X光片用于 确定用于临床评估的最佳射线照相成像配置。