Analysis and Optimization of the Pavlik Harness Treatment of Neonates with Hip Dysplasia

Pavlik吊带治疗新生儿髋关节发育不良的分析与优化

• 批准号: 1160179
• 负责人: Alain Kassab
• 金额: $ 34.05万
• 依托单位: The University of Central Florida Board of Trustees
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1160179&HistoricalAwards=false
• 关键词: Analysis; Optimization; Pavlik; Harness; Treatment

PI: KassabProposal 1160179The Pavlik harness is the standard orthopaedic device utilized worldwide to non-surgically correct congenital hip dysplasia (CHD) in infants, but its mechanism of action has not been studied, and is therefore little understood. As a result, treatment with this device fails for about 15% of the patients. Nearly 76% of hip osteoarthritis cases are attributed to untreated hip dysplasia at an early stage in life and this disability usually requires total hip replacement before the age of 50. It is estimated that nearly 1/20 full term infants are born with some type of hip instability, of which 2-3 out of 1000 will require treatment, and that nearly 15% will fail treatment for CHD with the Pavlik Harness leading to disability as the ultimate consequence. Accepting the rate of failure of this device as a leading cause of disability as a result of hip osteoarthritis, we propose to use the results of our year-long preliminary study as the foundation to engage in the hereby proposed research project where we will use engineering fundamentals to develop a case-specific approach to the treatment of CHD based on data extracted from individual CT-scans of infants afflicted by the condition. To do this we propose to: (1) develop a finite element model of the dynamic physiological response of the hip due to loads imposed by the Pavlik harness based on patient specific infant geometry, accounting for large deformation and non-linear behavior of the musculature, (2) formulate an automated algorithm based on the principle of minimum energy to determine optimum Pavlik harness load components necessary to successfully vector the femoral heads into their correct physiological position in the acetabula, while maintaining hip reduction for the full length of treatment, and (3) establish the proposed FEM-optimization methodology as a planning tool to achieve the goal of computationally determining patient-specific optimal configuration of the Pavlik harness allowing the optimum configuration to be transferred to the recipient infant, aiding in the success of the treatment. This will also serve in training physicians to successfully use and apply the Pavlik Harness.Intellectual Merit: The primary intellectual merit of this project is the expectation that our study will provide insight into the mechanisms of the successful treatment of CHD and suggest feasible clinical methods aimed at reducing the rate of failure of the treatment with the Pavlik Harness. Because no characterization has been made of the mechanism of action of this common orthopaedic device, the results of this project would constitute a breakthrough in the understanding and treatment of CHD. We have devised a multi-disciplinary framework, bringing together engineering analysis via finite element modeling, to predict optimal configuration of the Pavlik Harness geometry for each patient and serving to guide treatment planning. Although the ?optimal? configuration is not universal, we will have devised a universal patient-specific treatment planning procedure. Another intellectual merit is that this is truly an interdisciplinary research program bringing together medical professionals and engineers in an integrated and complementary approach providing a physics-based framework to approach a practical medical problem whose solution has a critical impact on a large patient population.Broader Impact: The primary impact of this project on society will be to ultimately improve the quality of life of patients with CHD that are undergoing corrective treatment using the Pavlik Harness. This study offers a practical solution to achieve effective treatment that draws from engineering expertise and modeling capabilities integrated with medical input and knowledge. Moreover, since 120,000 total hip replacements are performed annually in the United States, early detection and non-surgical correction of CHD in infants can potentially prevent enormous subsequent health-related costs. Also, graduate and undergraduate students will be immersed into a highly interdisciplinary working environment as by its very nature, the project requires students to synthesize learning from several engineering courses and physical sciences in a real-life problem of importance to society. Students are very eager to get involved in such projects that are at the interface of engineering and medicine. The bioengineering research activities of the Co-PIs have attracted a number of students including several females and Hispanic, several of whom have won science and engineering technical competitions, one on a pilot study of the very topic of this grant proposal. The College of Engineering and Computer Science (CECS) at UCF is ranked as the 3rd college of choice for Hispanics in the US by the Hispanics Business Magazine, and this project offers a unique means of recruiting such students in the field of bioengineering.

主要研究者：Kassab提案1160179 Pavlik背带是全世界用于非手术矫正婴儿先天性髋关节发育不良（CHD）的标准矫形器械，但其作用机制尚未研究，因此了解甚少。因此，使用该装置的治疗对约15%的患者失败。近76%的髋关节骨关节炎病例归因于生命早期未经治疗的髋关节发育不良，这种残疾通常需要在50岁之前进行全髋关节置换术。据估计，近1/20的足月婴儿出生时患有某种类型的髋关节不稳定，其中每1000例中有2-3例需要治疗，近15%的CHD治疗失败，最终导致残疾。接受该器械的失效率作为髋关节骨关节炎导致残疾的主要原因，我们建议使用我们长达一年的初步研究结果作为基础，参与特此提出的研究项目，我们将使用工程学基础知识，根据从患有该疾病的婴儿的个体CT扫描中提取的数据，开发一种治疗CHD的病例特异性方法。为此，我们建议：（1）基于患者特定的婴儿几何形状，考虑到肌肉组织的大变形和非线性行为，开发由于Pavlik安全带施加的载荷而引起的髋关节的动态生理响应的有限元模型，（二）根据最小能量原则制定自动算法，以确定成功引导股骨头进入其正确位置所需的最佳Pavlik线束载荷分量，在髋臼中的生理位置，同时在整个治疗期间保持髋关节复位，以及（3）建立所提出的FEM优化方法作为计划工具，以实现通过计算确定Pavlik背带的患者特定最佳配置的目标，从而允许将最佳配置转移到受体婴儿，帮助治疗成功。这也将有助于培训医生成功地使用和应用Pavlik ™。智力价值：本项目的主要智力价值是期望我们的研究将提供对成功治疗CHD的机制的深入了解，并提出旨在降低Pavlik ™治疗失败率的可行临床方法。由于尚未对这种常见骨科器械的作用机制进行表征，因此该项目的结果将构成对CHD理解和治疗的突破。我们设计了一个多学科框架，通过有限元建模将工程分析结合在一起，以预测每个患者的Pavlik几何形状的最佳配置，并指导治疗计划。虽然，？最佳？如果配置不是通用的，我们将设计出通用的患者特异性治疗计划程序。另一个智力上的优点是，这是一个真正的跨学科研究计划，汇集了医疗专业人员和工程师在一个综合和互补的方法，提供了一个基于物理学的框架，以接近一个实际的医疗问题，其解决方案对大量的患者群体有着至关重要的影响。该项目对社会的主要影响将是最终改善使用Pavlik支架进行矫正治疗的CHD患者的生活质量。这项研究提供了一个实用的解决方案，以实现有效的治疗，从工程专业知识和建模能力与医疗输入和知识相结合。此外，由于美国每年进行120，000例全髋关节置换术，因此婴儿CHD的早期检测和非手术矫正可能会潜在地防止随后的巨大健康相关费用。此外，研究生和本科生将沉浸在一个高度跨学科的工作环境中，因为该项目的本质要求学生在对社会重要的现实问题中综合学习多个工程课程和物理科学。学生们非常渴望参与这些工程和医学的接口项目。Co-PI的生物工程研究活动吸引了许多学生，包括一些女性和西班牙裔学生，其中一些人赢得了科学和工程技术竞赛，其中一个是关于本赠款提案主题的试点研究。UCF的工程与计算机科学学院（CECS）被西班牙裔商业杂志评为美国西班牙裔的第三所大学，该项目提供了在生物工程领域招募此类学生的独特手段。