Muscle Geometry and its Influence on Function in Patients with Developmental Dysplasia of the Hip

发育性髋关节发育不良患者的肌肉几何形状及其对功能的影响

基本信息

批准号：
10376199
负责人：
Michael D Harris
金额：
$ 11.08万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10376199
关键词：
3-Dimensional Adolescence Adolescent Adolescent and Young Adult Adult Affect Biomechanics Biomedical Engineering Bone structure Clinical Clinical Research Data Degenerative polyarthritis Development Development Plans Disease Dysplasia Ensure Equilibrium Etiology Evaluation Exercise Femur Generations Geometry Goals Hip Osteoarthritis Hip region structure Individual Intervention Joints Knowledge Laboratories Lateral Lead Lesion Link Magnetic Resonance Imaging Measurement Measures Mechanics Mentors Modeling Morphology Motion Movement Muscle Muscle Weakness Muscle function Musculoskeletal Operative Surgical Procedures Orthopedics Pain Patient Outcomes Assessments Patient Selection Patient-Focused Outcomes Patients Prevention Rehabilitation therapy Replacement Arthroplasty Reporting Risk Role Severities Shapes Structure Surgeon Symptoms Techniques Testing Three-dimensional analysis Torque Total Hip Replacement Training Treatment outcome Validation Work acetabulum arm articular cartilage bone bone geometry common symptom improved in vivo joint injury joint loading meetings muscle strength muscular structure novel pain perception pain score pain symptom pathomechanics physical conditioning physical therapist preservation radiological imaging rehabilitation strategy restoration skills soft tissue strength training surgery outcome symptomatology treatment optimization treatment strategy young adult

项目摘要

PROJECT SUMMARY Developmental dysplasia of the hip (DDH) dramatically increases risk for early development of hip osteoarthritis (OA) in adolescents and young adults. In cases of DDH, abnormal development of the acetabulum (hip socket) and femur alter loading inside the joint, which can lead to painful acetabular labrum tears and articular cartilage lesions. Without correction, this joint damage progresses to OA and may require total joint replacement. Pain and physical limitation are common symptoms in patients with DDH. However, the presentation, intensity and combination of symptoms do not always correspond with radiographic signs of bony abnormalities or soft-tissue damage. Factors beyond bony structure, such as muscle function, likely contribute to symptom onset and altered joint loading, but the role of muscle in DDH pathomechanics is not well understood. This project will be the first to rigorously investigate the bone-muscle relationship as a factor in pathomechanics and symptomatology in patients with DDH. In Aim 1, we will use magnetic resonance imaging (MRI) and musculoskeletal models to compare hip muscle volumes, 3D muscle moment arms, and muscle strength between patients with DDH and control subjects. Aim 1 will provide the first 3D analyses of muscle geometry and moment arms in patients with DDH, and may elucidate relationships among muscle alterations, the severity of bony abnormalities, and muscle weakness. In Aim 2, we will use 3D motion capture to quantify hip movement and loading during activities of increasing biomechanical demand. Analyzing a range of activities that are common for our patients with DDH can identify mechanical distinctions between patients and control subjects that contribute to symptoms and joint damage. In Aim 3, we will identify translational relationships between our laboratory measures and clinical measures of patient reported outcomes (PROs). Identifying such relationships can establish novel links between important realms of patient evaluation – laboratory measurement and clinical research. Ultimately, we seek coordinated surgical and nonsurgical approaches that optimize joint loading and balance muscle use to improve treatment and delay OA for patients with DDH. Thus, in an exploratory Aim 4, we will compare bone-muscle geometry, strength, hip mechanics, and PROs one year after hip preservation surgery to pre-surgical values and determine the variables predictive of post-surgical outcomes. This proposal builds on the candidate's prior work in intra-articular mechanics and bone morphology and provides new training in MRI, strength testing, modeling, and clinical research with patients with hip disorders. The mentor team consists of physical therapists, orthopedic surgeons and bioengineers who are experts in muscle structure-function, MRI, OA development, and clinical intervention for DDH. Together, the results from this proposal will provide preliminary data for an R01 focused on key factors that affect patient outcomes after surgical and nonsurgical intervention for DDH.

项目摘要髋关节发育不良（DDH）显着增加了髋关节早期发展的风险青少年和年轻人的骨关节炎（OA）。在DDH的情况下，异常发展髋臼（髋关节插座）和股骨在关节内部载荷，这可能导致疼痛的髋臼唇眼泪和关节软骨病变。没有校正，这种关节损伤会发展为OA，可能需要总关节置换。疼痛和身体限制是DDH患者的常见症状。但是，符号的演示，强度和组合并不总是与奖励的X光迹象相对应异常或软组织损害。超出键结构的因素，例如肌肉功能，可能会贡献症状发作和关节负荷改变，但是肌肉在DDH病理学中的作用不好理解。该项目将是第一个严格研究骨肌肉关系的一个因素 DDH患者的病理学和症状学。在AIM 1中，我们将使用磁共振成像（MRI）和肌肉骨骼模型比较髋部肌肉量，3D肌肉臂和肌肉 DDH患者和对照组患者之间的强度。 AIM 1将提供肌肉的第一个3D分析 DDH患者的几何和矩臂，并可能阐明肌肉改变之间的关系，债券异常的严重程度和肌肉无力。在AIM 2中，我们将使用3D运动捕获来量化在生物力学需求增加的活动中，髋关节运动和负载。分析一系列我们DDH患者常见的活动可以确定患者之间的机械区别控制症状和关节损害的受试者。在AIM 3中，我们将确定翻译我们的实验室测量与患者报告结果的临床测量之间的关系（PRO）。确定这种关系可以在患者评估的重要领域之间建立新的联系 - 实验室测量和临床研究。最终，我们寻求协调的外科手术和非手术优化关节载荷和平衡肌肉用途以改善患者治疗和延迟OA的方法与DDH。在探索性目标4中，我们将比较骨肌肉的几何形状，力量，髋部力学，和髋关节保存手术后一年以进行手术前值并确定变量预测后手术后的结果。该提案是基于候选人在关节内技工和骨形态学，并提供新的MRI，强度测试，建模和临床研究的培训髋关节疾病的患者。导师团队由物理治疗师，骨科医生和是肌肉结构功能，MRI，OA开发和临床干预专家的生物工程师 DDH。总之，该提案的结果将为R01提供初步数据，该数据的重点是关键因素这会影响DDH手术和非手术干预后的患者预后。