Preclinical computational simulation of fracture healing in children

儿童骨折愈合的临床前计算模拟

• 批准号: 445465815
• 负责人: Professor Dr.-Ing. Ulrich Witzel
• 金额: --
• 依托单位: Lehrstuhl für Produktentwicklung
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2020
• 资助国家: 德国
• 起止时间: 2019-12-31 至 2021-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/445465815?language=en
• 关键词: Preclinical; computational; simulation; fracture; healing

Computational simulations can be used in (pediatric) orthopedics to model functional adaption of biological structures and bone metabolism. Finite element method can calculate numerically mechanical stresses. The simulations are able to model secondary fracture healing with callus development, bone remodeling, and growth. Existing algorithms consider cell differentiation, production and removal of extracellular matrix, vascularisation, cell migration and proliferation, dynamic loads, growth factors, patient specific models, dislocated fractures, and virtual implantation. These simulations can predict healing outcome of treatment options and be used to optimize implants and treatments: Once simulations are validated by high accordance of simulation results with patient cases or animal studies these simulations can be used to test and improve implants and treatments cost- and time-effective previous to clinical use or animal testing. While there are many simulations of fracture healing in adults, at the moment no simulation of fracture healing in children is available. Although pediatric fracture healing proceeds in the same stages as in adults and healing is often fast and without complication, the specific growth situation needs to be addressed: Malalignment can be adjusted easier, but also occur due to overgrowth or growth arrest. Another complication is secondary fracture during healing. Infrequently used implants for pediatric osteosynthesis exacerbate implant improvement by statistical means. Virtual strength measurements during healing simulations can help to reduce refractures and provide needs for implant design. The finite element software calculates mechanical stresses due to external forces and hormone concentration by diffusion-reaction models. The algorithm defines the resulting cell processes. By this morphology, external loads and muscle forces, and endocrine characteristics of a patient can be incorporated. For this purpose algorithms for growth, remodeling, and healing simulation are combined. A shaft and an epiphyseal fracture are simulated and compared to clinical healing outcome.

计算模拟可用于（儿科）骨科，以模拟生物结构和骨代谢的功能适应。有限元法可以数值计算机械应力。模拟能够模拟具有骨痂发育、骨重塑和生长的继发性骨折愈合。现有算法考虑细胞分化、细胞外基质的产生和去除、血管形成、细胞迁移和增殖、动态载荷、生长因子、患者特定模型、脱位骨折和虚拟植入。这些模拟可以预测治疗方案的愈合结果，并用于优化植入物和治疗：一旦模拟通过模拟结果与患者病例或动物研究的高度一致性进行验证，这些模拟可用于在临床使用或动物试验之前测试和改善植入物和治疗的成本和时间效益。虽然有许多成人骨折愈合的模拟，但目前还没有儿童骨折愈合的模拟。虽然儿科骨折愈合的进展与成人相同，愈合通常很快，没有并发症，但需要解决特定的生长情况：对线不良可以更容易调整，但也可能由于过度生长或生长停滞而发生。另一个并发症是愈合过程中的继发性骨折。通过统计学方法，儿科骨接合术中不常使用的植入物加剧了植入物的改善。愈合模拟过程中的虚拟强度测量有助于减少并发症，并为植入物设计提供需求。有限元软件通过扩散反应模型计算外力和激素浓度引起的机械应力。该算法定义了产生的细胞过程。通过这种形态，可以结合患者的外部负荷和肌肉力以及内分泌特征。为此，结合了用于生长、重塑和愈合模拟的算法。模拟骨干和骨骺骨折，并与临床愈合结果进行比较。