GLENOHUMERAL JOINT STABILITY: ROLE OF THE CAPSULE

盂肱关节稳定性：胶囊的作用

• 批准号: 6774602
• 负责人: Richard E Debski
• 金额: $ 26.42万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6774602
• 关键词: biomechanics; collagen; human tissue; joints; limb movement; postmortem; shoulder

DESCRIPTION (provided by applicant): The shoulder is the most frequently dislocated joint of the body. Up to 90% of individuals less than 25 years of age that dislocate their glenohumeral joint and have unidirectional anterior instability suffer recurrence that is difficult to diagnose and necessitates surgical repair. Following surgical treatment, return to normal function remains inadequate with unsatisfactory results in 20-25% of patients due to loss of range of motion, recurrent instability, rotator cuff damage, or osteoarthritis. Therefore, research efforts to better understand the function of the passive stabilizers of the shoulder are needed to design better diagnostic protocols and surgical approaches as well as to improve the long-term outcome. The overall hypothesis is that the outcome of shoulder surgery will be improved when the repaired glenohumeral capsule can reproduce the function of the intact shoulder, both at the immediate post-operative periods and in the long-term. Current models of the shoulder stabilizers describe the glenohumeral capsule as a collection of uniaxial elements (glenohumeral ligaments). Therefore, the goal of this project is to perform a comprehensive analysis of the anatomy and biomechanics of the glenohumeral capsule using a novel model of anterior glenohumeral joint stability. The proposed work will utilize a combined experimental and computational approach to characterize the structure and function of the glenohumeral capsule in clinically relevant joint positions. The three Specific Aims of this proposal are: 1) quantify the local multi-axial material properties, microstructural morphology and appropriate constitutive model of the posterior, antero-superior and antero-inferior regions of the glenohumeral capsule as a function of age and gender; 2) develop and validate subject-specific finite element models of the glenohumeral capsule in clinically relevant joint positions; and 3) determine the stress and strain distribution as well as force in the glenohumeral capsule using subject-specific finite element models with the joint in mid-abduction, abduction and apprehension positions. The quantitative data obtained from these innovative and validated models is the first critical step towards the development of new biomechanically based strategies for improved diagnostic procedures and surgical repair following shoulder dislocation. This methodology will also serve as the state-of-the-art for analysis of other joint capsules throughout the musculoskeletal system.

描述（由申请人提供）：肩部是身体最常脱臼的关节。高达 90% 的 25 岁以下盂肱关节脱位且具有单向前不稳定的个体会出现难以诊断且需要手术修复的复发。手术治疗后，由于活动范围丧失、反复不稳定、肩袖损伤或骨关节炎，20-25% 的患者恢复正常功能仍然不够，结果不令人满意。因此，需要开展研究工作，更好地了解肩部被动稳定器的功能，以设计更好的诊断方案和手术方法，并改善长期结果。总体假设是，当修复后的盂肱关节囊能够在术后即刻和长期内重现完整肩部的功能时，肩部手术的结果将会得到改善。当前的肩部稳定器模型将盂肱关节囊描述为单轴元件（盂肱韧带）的集合。因此，该项目的目标是使用一种新颖的前盂肱关节稳定性模型对盂肱关节囊的解剖学和生物力学进行全面分析。拟议的工作将利用实验和计算相结合的方法来表征临床相关关节位置的盂肱关节囊的结构和功能。该提案的三个具体目标是：1）根据年龄和性别，量化盂肱关节囊后部、前上和前下区域的局部多轴材料特性、微观结构形态和适当的本构模型； 2) 开发并验证临床相关关节位置的盂肱关节囊的特定受试者有限元模型； 3) 使用特定对象的有限元模型，在关节处于中间外展、外展和逮捕位置的情况下，确定盂肱关节囊中的应力和应变分布以及力。从这些创新且经过验证的模型中获得的定量数据是开发基于生物力学的新策略的第一个关键步骤，以改进肩关节脱位后的诊断程序和手术修复。该方法也将成为分析整个肌肉骨骼系统其他关节囊的最先进方法。