OMEGA - Optimization-based forward musculoskeletal simulation of pathological gait

了解人体及其各部位的运动和负荷在人类医学的许多领域都是必不可少的，特别是在骨科和创伤外科。现代数值方法已经发展到可以基于先验知识、运动和外载荷来估计相关结构的力。然而，它们的一般用途受到限制，因为它们无法预测运动和负荷，以响应由疾病引起的身体变化，或作为应用特定疗法治疗疾病的结果。该项目的目的是开发新一代的前向模拟器，基于最优运动的计算，以预测并从而改善个体患者的治疗策略。这种模拟器将有助于将医学从纯粹的经验方法（依赖于仅基于证据的治疗方法的发展）转移到可能指导和预测治疗的程度。一种创新的向前肌肉骨骼模拟器（FMS）将为此目的而开发和实施。虽然模拟器在未来可以应用于广泛的肌肉骨骼疾病，但它将首先在三种特别选择的临床情况下进行测试和进一步发展：膝关节和踝关节支撑，下垂足病理，以及用微处理器控制的膝关节假体治疗的膝上截肢。选择这三种临床情况是因为它们具有很好的特征，治疗方式可以无创地改变而不会给患者带来不必要的风险，并且有足够数量的患者可用。虽然相对简单，但这些病理中的每一种都代表着受影响患者生活质量的严重下降，治疗方法的普遍改善，特别是治疗方式适应个别患者的需要，将对生活质量产生严重影响。在所有三种情况下，将在临床步态分析实验室的背景下开发一个框架，通过使用直接运动学和动力学测量以及逆动态模拟的组合来验证和进一步开发，作为从各自患者群体获得的真实数据。FMS预测能力未来最明显的应用领域之一是治疗晚期髋关节和膝关节OA，即全髋关节（THA）和全膝关节置换术（TKA）。这些程序的费用是一个重大的和日益增加的经济挑战。这进一步表明了在该项目中进行的基础研究的重要性，并显示了重大的医疗和经济影响：改善了与肌肉骨骼疾病有关的许多情况下的治疗方法，并为预测治疗结果提供了强有力的新方法。

Knowledge of the motion and loading of the human body and its parts is essential in many fields of human medicine and in particular in orthopedic and trauma surgery. Modern numerical methods have advanced to the point that they are useful for estimating forces in the relevant structures based on a priori knowledge motion and external loading. However, their general usefulness is limited by their inability to predict motion and loading in response to changes in the body caused by disease or as a result of applying a given therapy to treat a disease. The aim of this project is to develop a new generation of forward simulator, based on the computation of most optimal motions, with the promise of predicting and thus improving therapeutic strategies for individual patients. Such simulator will help moving medicine away from a purely empirical approach which relies on the evolution of therapies based on evidence alone, to a point where guiding and predicting therapies is possible. An innovative forward musculoskeletal simulator (FMS) will be developed and implemented for this purpose. Although the simulator could in the future be applied to a wide range of musculoskeletal disorders it will first be tested and further evolved in three specially selected clinical situations: Knee and Ankle Bracing, Drop Foot Pathology, and Above Knee Amputation treated with a microprocessor-controlled knee-prosthesis. These three clinical situations were chosen because they are well characterized, treatments modalities can be altered non-invasively without undue risk to the patients, and sufficient numbers of patients are available. Although relatively simple, each of these pathologies represents a serious reduction in quality of life for the affected patients and general improvements in treatment approaches and in particular the adaptation of treatment modalities to the needs of individual patients will have a serious impact on quality of life. In all three cases a framework will be developed in the context of a clinical gait analysis laboratory, validated and further developed by using a combination of direct kinematic and kinetic measurements and inverse dynamic simulations as ground-truth data obtained from respective patient collectives.One of the most obvious areas of future application of the predictive capabilities of FMS is the treatment of advanced OA of the hip and knee, i.e. total hip (THA) and total knee arthroplasty (TKA). The cost of these procedures represents a significant and increasing economic challenge. This is a further indication of the significance of the basic-research to be performed in this project and demonstrates a major medical and economic impact: improving the treatment of, and providing powerful new methods for predicting the outcome of treatments in many contexts related to musculoskeletal diseases.