Characterizing dynamic thumb metacarpal subsidence during functional tasks after trapeziectomy

项目摘要/摘要：拇指腕掌关节(CMC)是第二常见的部位。 人类的骨关节炎(OA)和上肢骨关节炎最常见的外科重建部位 极端。目前的护理标准包括切除梯形骨，然后进行软组织修复。 以防止手术后拇指近端移位(下沉)导致的力量丧失。证据 关于梯形切除后力量丧失与拇指掌骨下沉有关的结论尚不确定， 因此，这些额外程序的必要性仍然存在争议。这项研究的主要目标是 阐明拇指掌骨下沉与拇指力量的关系，并开发和验证 一种新的利用2D准确估计拇指掌骨动态下沉的成像方案 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估 患者在斜方形切除后，可能会导致一种更有效的手术程序，以恢复力量后 梯形切除术。这项研究将包括50名患者，他们接受了梯形切除，随后接受了LRTI或 在过去6个月至12个月内行悬吊术。我们将使用动态双平面摄影技术来测量3D 拇指掌骨运动学同时测量捏、握、罐过程中的拇指指力 开场了。接下来，我们将使用前30名患者的3D成像数据来开发一种新的成像方案，以 应用二维片评估拇指掌骨动态下沉。然后将对新协议进行验证 剩下的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。实现这一目标将解决我们关于拇指如何 斜方形术后下沉会影响力量。在理解运动学如何与 力量可以用来改进涉及梯形切除的外科手术。第二个具体目标是 开发和验证一种新的临床成像方案以准确估计动态拇指掌骨 梯形切除后的下沉。在这个目标中，我们将根据患者的具体情况生成模拟的X光照片 确定测量拇指掌骨的最佳成像构型的骨骼及其姿势 下沉。这将克服存在的障碍，准确地评估拇指掌骨下沉 使用临床放射照片，这将导致与测量相关的生物医学和临床研究的改进 斜方形术后拇指下沉。这项研究的结果可以用来指导设计更好的 CMC骨性关节炎患者的手术方式，以改善梯形切除后下沉的临床评估， 并使涉及梯形切除后患者的大规模临床试验成为可能。这项研究将是第一个 双平面摄影与测力相结合表征拇指动态运动学和载荷 它提出了一种新的方法来使用数字重建的射线照片来 确定用于临床评估的最佳放射成像配置。

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.