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网站， 骨关节炎（OA）是人类中最常见的骨关节炎， 上肢的目前的护理标准包括去除骨水泥，然后进行软组织修饰 以防止由于手术后拇指近端移位（下沉）而导致的强度损失。证据 证明颧骨切除术后的力量损失与拇指掌骨下沉有关是不确定的， 因此，是否需要这些额外的程序仍然存在争议。本研究的主要目的是 阐明拇指掌骨下沉与拇指力量的关系，并进行验证 一种新的成像协议，可以使用2D精确估计动态3D拇指掌骨下沉 X光片实现这些目标将改善未来的生物医学研究和临床评价， 手术后的患者，并可能导致更有效的外科手术恢复后的力量 脊椎切除术这项研究将包括50名接受腰椎切除术后接受LRTI或 在过去的6到12个月内进行悬吊成形术。我们将使用动态双平面X线摄影来测量3D 拇指掌骨运动学，同时测量捏、抓和震击过程中的拇指力 开放后接下来，我们将使用前30名患者的3D成像数据来开发新的成像协议， 使用2D X线片估计动态拇指掌骨下沉。然后将对新协议进行验证 剩下的20个病人。第一个具体目的是确定拇指掌骨之间的关系， 下沉和拇指强度。实现这一目标将解决我们知识上的差距， 下颌骨切除术后下沉影响强度。这一进展在理解运动学是如何与 强度可用于改进涉及脊椎切除术的外科手术。第二个具体目标是 开发并验证新的临床成像方案，以准确估计动态拇指掌骨 下颌骨切除术后下沉。在这个目标中，我们将从患者特定的 骨骼及其姿势，以确定测量拇指掌骨的最佳成像配置 下沉这将克服准确评估拇指掌骨下沉存在的障碍 使用临床放射照片，它将导致改善生物医学和临床研究有关的测量 拇指下垂这项研究的结果可以用来通知设计一个更好的 CMC OA患者的外科手术，以改善胫骨切除术后下沉的临床评价， 并使大规模的临床试验，涉及病人后，脊椎切除术。这项研究将是第一个 结合联合收割机双平面X线摄影和力测量，以表征动态拇指运动学和负载， 它提出了一种新的方法，使用数字重建的射线照片， 确定用于临床评价的最佳射线照相成像配置。

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.