How Do Wrist Surgical Salvage Procedures Limit Hand Strength?

手腕抢救手术如何限制手部力量？

• 批准号: 10336396
• 负责人: Wendy M Murray
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10336396
• 关键词: Activities of Daily Living; Adopted; Affect; Area; Arthritis; Articular Range of Motion; Biomechanics; Cadaver; Clinical; Clinical Treatment; Computer Simulation; Coupling; Data; Degenerative polyarthritis; Distal; Engineering; Excision; Extensor; Fascicle; Forearm; Funding; General Population; Geometry; Goals; Gold; Hand; Hand Strength; Hand functions; Hip Osteoarthritis; Hip region structure; Implant; Individual; Injury; Investments; Isometric Exercise; Joints; Knee Osteoarthritis; Knee joint; Knowledge; Lateral; Lead; Length; Link; Measures; Mechanics; Military Personnel; Motion; Muscle; Muscle function; Musculoskeletal; Operative Surgical Procedures; Orthopedics; Outcome; Patient-Focused Outcomes; Patients; Population; Positioning Attribute; Postoperative Period; Prevalence; Procedures; Process; Protective gloves; Protocols documentation; Quality of life; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Research; Scaphoid bone; Scientific Advances and Accomplishments; Semilunar Bone; Specimen; Surgeon; Techniques; Technology; Tendon Transfer; Tendon structure; Testing; Torque; Training; Ultrasonography; Upper Extremity; Veterans; Work; Wrist; Wrist Injuries; Wrist joint; active duty; base; biomechanical model; bone; carpus bone; design; expectation; experience; functional restoration; grasp; hand dysfunction; improved; improved outcome; in vivo; innovation; kinematics; military operation; military veteran; neglect; non-compliance; novel; older men; pain reduction; prevent; research study; strength training; success; wrist function

Wrist osteoarthritis has been described as “one of the most common conditions encountered by the orthopaedic surgeon”. In men older than 60, severe osteoarthritis is more frequently present at the wrist than the hip. The wrist is a complicated joint that implant technology has failed to effectively replicate. As a result, surgical salvage procedures are commonly used to treat osteoarthritis at the wrist, unlike at the hip or knee where joint replacement is the gold standard. The two most common surgical salvage procedures are scaphoid-excision four-corner fusion (SE4CF) and proximal row carpectomy (PRC). In each procedure, the arthritic scaphoid bone is removed. In SE4CF, the midcarpal joint (the interface between the remaining bones in the proximal and distal rows) is fused to prevent carpal collapse in the absence of the scaphoid. In PRC, the lengths of the carpus and distal upper limb are shortened because the two additional bones (lunate, triquetrum) that articulate with the forearm are also removed. These drastic geometric and kinematic re-designs permanently decrease wrist range of motion and grip strength. Loss of grip strength is particularly detrimental; it limits patient's abilities to perform activities of daily living, such as picking up a saucepan, unscrewing a jar lid, and opening a door. Why grip strength is lost following surgical salvage procedures is not understood. Our long-term goal is to develop innovative orthopaedic surgical interventions for wrist osteoarthritis. The objective of this proposal, the next step toward attainment of that goal, is to determine why grip force is limited following PRC and SE4CF. Our central hypothesis is that the surgical re-design of the wrist in PRC and SE4CF impose mechanical differences in muscle function at the wrist joint, and it is these effects that ultimately limit hand strength post-operatively. Our hypothesis was developed based on our preliminary work, in which we first characterized biomechanical differences between muscle mechanical capabilities in nonimpaired and surgically salvaged wrist joints in cadaveric specimens, and then demonstrated the impact of these mechanical effects on lateral pinch strength using computer simulation. The rationale that underlies the proposed research is that improving surgical interventions for wrist osteoarthritis first requires understanding how changing the kinematic and geometric design of the wrist joint influences the hand's ability to generate force. Ultimately, the research studies proposed here will improve the scientific understanding of how the design of the wrist influences both wrist and hand function. This knowledge will aid therapists in designing rehabilitation protocols targeted at specific points of biomechanical weakness and surgeons in developing novel surgical techniques to reduce biomechanical changes. For example, if muscle adaptations cause wrist extensors to be weaker following PRC, a tendon transfer to strengthen these muscles could be performed. Alternatively, SE4CF could be modified to minimize the effects of motion coupling by optimizing the position in which the carpals are fused. Additionally, engineers will be able to use our findings to design wrist implants that more effectively replicate key components of the wrist's design. All of these outcomes will improve the treatment options for wrist osteoarthritis, and thereby lead to improved patient outcomes and quality of life. The overwhelming success of treatment options for hip and knee osteoarthritis, as well as the scientific advances that have been achieved in these areas over the past 25 years, emphasizes the potential impact that an increased investment in research relevant to wrist osteoarthritis could have. Because the veteran population is so much more susceptible to wrist injuries than the general population, veterans would ultimately reap the most benefits from such improvements in clinical treatment of wrist osteoarthritis.

腕关节骨关节炎已被描述为“最常见的条件之一， 整形外科医生”。在60岁以上的男性中，严重的骨关节炎更常见于手腕， 臀部手腕是一个复杂的关节，植入技术未能有效复制。因此，在本发明中， 与髋关节或膝关节不同，外科挽救手术通常用于治疗腕关节骨关节炎 关节置换术是黄金标准两种最常见的外科挽救手术是 舟骨切除四角融合术（SE 4CF）和近排腕骨切除术（PRC）。在每个过程中， 关节炎的舟状骨被移除。在SE 4CF中，腕中关节（剩余骨骼之间的界面） 在近侧和远侧行中）被融合以防止在舟状骨缺失的情况下腕骨塌陷。在中国， 腕骨和上肢远端的长度缩短，因为两个额外的骨头（月骨，三角骨） 与前臂连接的部分也被移除这些剧烈的几何和运动学重新设计 永久性地减少手腕的活动范围和握力。握力的损失是特别有害的; 它限制了患者进行日常生活活动的能力，例如拿起平底锅，拧开罐子， 盖，打开一扇门。为什么在外科挽救手术后会失去握力还不清楚。我们 长期目标是为腕关节骨关节炎开发创新的整形外科干预措施。客观 为了达到这个目标，下一步是确定为什么握力是有限的， PRC和SE 4CF。我们的中心假设是PRC和SE 4CF中腕关节的手术重新设计 腕关节肌肉功能的机械差异，正是这些影响最终限制了手 术后强度。我们的假设是基于我们的初步工作，其中我们首先 未受损和未受损的肌肉机械能力之间的特征性生物力学差异 手术挽救了尸体标本的腕关节，然后证明了这些机械的影响， 横向挤压强度的影响，使用计算机模拟。拟议研究的基本原理 改善腕关节骨关节炎的手术干预首先需要了解如何改变 腕关节的运动学和几何设计影响手产生力的能力。最终 这里提出的研究将提高对手腕设计的科学理解， 影响手腕和手的功能。这些知识将有助于治疗师设计康复方案 针对生物力学薄弱点和外科医生开发新的手术技术， 减少生物力学变化。例如，如果肌肉适应导致腕伸肌变弱， 在PRC之后，可以进行肌腱转移以加强这些肌肉。或者，SE 4CF可以 通过优化腕骨融合的位置来修改以最小化运动耦合的影响。 此外，工程师将能够使用我们的研究结果来设计更有效地复制的手腕植入物， 手腕设计的关键部件。所有这些结果将改善腕关节的治疗选择 骨关节炎，从而导致改善的患者结果和生活质量。的巨大成功 髋关节和膝关节骨关节炎的治疗选择，以及在 这些领域在过去25年中，强调了增加研究投资的潜在影响， 与腕关节骨关节炎相关的疾病因为退伍军人群体更容易受到手腕 受伤的人数比一般人少，退伍军人最终将从这种改善中获得最大的好处。 临床治疗腕关节骨性关节炎。