Characterizing dynamic thumb metacarpal subsidence during functional tasks after trapeziectomy

项目摘要/摘要：拇指腕掌 (CMC) 关节是第二个最常见的部位 人类骨关节炎 (OA) 以及上颌骨 OA 手术重建的最常见部位 肢体。目前的护理标准包括去除梯形，然后进行软组织修改 防止手术后拇指近端迁移（下陷）导致力量损失。证据 证明梯形切除术后力量损失与拇指掌骨下沉有关尚无定论， 因此，是否需要这些额外的程序仍然存在争议。本研究的主要目标是 阐明拇指掌骨下陷与拇指力量之间的关系，并进行开发和验证 一种新的成像协议，可以使用 2D 准确估计动态 3D 拇指掌骨下沉 放射线照片。实现这些目标将改善未来的生物医学研究和临床评估 梯形切除术后的患者可能会采取更有效的手术方法来恢复术后力量 梯形切除术。这项研究将包括 50 名接受梯形切除术并随后接受 LRTI 或 过去 6 至 12 个月内进行过悬浮成形术。我们将使用动态双平面射线照相来测量 3D 拇指掌骨运动学，同时测量捏、抓和震击过程中的拇指力 开放。接下来，我们将使用前 30 名患者的 3D 成像数据来开发新的成像方案 使用 2D X 光片估计动态拇指掌骨下沉。然后将验证新协议 其余20名患者。第一个具体目标是确定拇指掌骨之间的关系 下沉和拇指力量。实现这一目标将弥补我们在如何拇指方面的知识差距 下沉影响梯形切除后的强度。这一进步在理解运动学如何与 力量可用于改善涉及梯形切除术的外科手术。第二个具体目标是 开发并验证一种新的临床成像协议，以准确估计动态拇指掌骨 梯形切除术后下陷。在这个目标中，我们将从患者特定的情况生成模拟放射线照片 骨骼及其姿势以确定测量拇指掌骨的最佳成像配置 沉降。这将克服准确评估拇指掌骨下沉的障碍 使用临床放射线照片将改善与测量相关的生物医学和临床研究 梯形切除术后拇指下陷。这项研究的结果可用于为更好的设计提供信息 CMC OA 患者的手术程序，以改善梯形切除术后下沉的临床评估， 并能够开展涉及梯形切除术后患者的大规模临床试验。这项研究将首次 结合双平面射线照相和力测量来表征动态拇指运动学和载荷 Vivo 在功能任务期间进行了研究，并提出了一种使用数字重建射线照片来 确定用于临床评估的最佳放射线成像配置。

Project Summary/Abstract: The thumb carpometacarpal (CMC) joint is the second most common site of osteoarthritis (OA) in humans and the most common site of surgical reconstruction for OA in the upper extremity. The current standard of care includes removal of the trapezium followed by soft tissue modifications to prevent loss of strength due to proximal migration of the thumb after surgery (subsidence). The evidence demonstrating that strength loss after trapeziectomy is related to thumb metacarpal subsidence is inconclusive, so the need for these additional procedures remains controversial. The primary objectives of this study are to clarify the relationship between thumb metacarpal subsidence and thumb strength, and to develop and validate a new imaging protocol that can accurately estimate dynamic 3D thumb metacarpal subsidence using 2D radiographs. Achieving these objectives will improve future biomedical research and clinical evaluation of patients after trapeziectomy and may lead to a more effective surgical procedure for restoring strength after trapeziectomy. This study will include 50 patients who received trapeziectomy followed by either LRTI or suspensionplasty within the past 6 to 12 months. We will use dynamic biplane radiography to measure 3D thumb metacarpal kinematics while simultaneously measuring thumb force during pinching, grasping and jar opening. Next, we will use 3D imaging data from the first 30 patients to develop a new imaging protocol to estimate dynamic thumb metacarpal subsidence using 2D radiographs. The new protocol will then be validated on the remaining 20 patients. The first Specific Aim is to determine the relationship between thumb metacarpal subsidence and thumb strength. Achieving this Aim will address the gap in our knowledge as to how thumb subsidence affects strength after trapeziectomy. This advance in understanding how kinematics are related to strength can be used to improve surgical procedures that involve trapeziectomy. The second Specific Aim is to develop and validate a new clinical imaging protocol to accurately estimate dynamic thumb metacarpal subsidence after trapeziectomy. In this Aim, we will generate simulated radiographs from patient-specific bones and their pose to identify the optimal imaging configuration for measuring thumb metacarpal subsidence. This will overcome the hurdle that exists for accurately evaluating thumb metacarpal subsidence using clinical radiographs and it will lead to improved biomedical and clinical research related to measuring thumb subsidence after trapeziectomy. The results of this study may be used to inform the design of a better surgical procedure for patients with CMC OA, to improve clinical evaluation of subsidence after trapeziectomy, and to enable large-scale clinical trials involving patients after trapeziectomy. This study will be the first to combine biplane radiography and force measurement to characterize dynamic thumb kinematics and loading in vivo during functional tasks and it proposes a novel approach to use digitally reconstructed radiographs to identify the optimal radiographic imaging configuration for clinical evaluation.