Quantifying Fracture Severity Using a 3-D Puzzle Solving Approach

使用 3-D 解谜方法量化骨折严重程度

• 批准号: 7529183
• 负责人: Donald D Anderson
• 金额: $ 20.15万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7529183
• 关键词: 3-Dimensional; Accounting; Acute; Ankle; Arthritis; Biomedical Engineering; Clinical; Comminuted Fracture type; Complication; Computational algorithm; Data; Degenerative polyarthritis; Development; Diabetes Mellitus; Disease; Etiology; Evaluation; Fracture; Goals; Gold; Health; Heart Diseases; Incidence; Individual; Injury; Intervention; Invasive; Investigation; Joints; Knee; Knowledge; Lasers; Limb structure; Measurement; Measures; Mechanics; Methods; Metric; Morbidity - disease rate; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Patients; Pattern; Positioning Attribute; Public Health; Research; Research Project Grants; Risk; Scanning; Series; Severities; Solutions; Specimen; Standards of Weights and Measures; Stroke; Surface; Surgeon; Techniques; Technology; Testing; Tissues; Trauma; Traumatic Arthropathy; Well in self; Work; X-Ray Computed Tomography; base; bone; cohort; disability; experience; functional outcomes; impression; indexing; innovation; novel; outcome forecast; prevent; research clinical testing; response; soft tissue; translational study; wound

DESCRIPTION (provided by applicant): The proposed research aims to advance innovative methods for the evaluation of patients who have sustained comminuted intra-articular fractures. The risk of post-traumatic osteoarthritis (PTOA), a late complication with substantial lifelong morbidity and disability, is related to the intensity of the joint trauma accompanying these fractures. Current methods for assessing the severity of joint injury are limited, irreproducible, and generally qualitative, hindering the evaluation of new treatments aimed at avoiding PTOA. Until the severity of the initial injury can be objectively measured, it will remain a substantial confounder hindering meaningful investigation. A global objective of the proposed work is to establish physically-grounded, non-invasive techniques to quantify intra-articular fracture severity. CT-derived measures of the mechanical energy expended in a given fracture provide an index of the mechanical insult to the joint. They do not account for localization of fragmentation, or fragment displacement and dispersal, critical factors reflecting the risk of PTOA, as this requires presently unavailable knowledge of the positions that the dispersed fragments originally occupied in the intact bone. Deducing this information entails, in effect, solving a three-dimensional (3-D) puzzle, a task for which suitable computational algorithms have recently begun to emerge. This new capability holds the potential to greatly advance the manner in which comminuted intra-articular fractures are assessed, facilitating investigation of new treatments (primarily biologic) aimed at restoring the health of at-risk articular tissues. Two specific aims will be pursued to advance 3-D puzzle solving methods for this use. Specific Aim 1 is to generate representative fracture fragmentation in test specimens machined from a bone surrogate material, and encased in a soft tissue surrogate. Fragment volumetric and surface data will be obtained from CT scans (intended clinical use), with fragments in their spontaneously-displaced/interspersed positions, and duplicate surface data will be obtained from ensuing laser scans of individual fragments (gold standard). Working from these data, the accuracy of fracture fragment segmentation, and 3-D puzzle solution accuracy in reconstructing the known pre- fracture specimen geometry, will be determined. Specific Aim 2 is to obtain 3-D puzzle solutions, and associated fracture severity indices, working from an existing series of tibial plafond fracture cases for which three to five year outcome data will be available. Fracture severity metrics will be correlated with a clinical rank ordering of severity, and in turn with the clinical incidence of PTOA, and with functional outcome measures. PUBLIC HEALTH RELEVANCE: Patients sustaining severe limb trauma in which bones are highly fragmented and the fracture extends into an articular joint such as the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling outcome. Lacking objective measures of fracture severity, surgeons presently rely upon subjective impressions to guide treatment of these patients, hindering progress toward forestalling post-traumatic arthritis. A 3-D puzzle solving approach yields new, objective measures of articular fracture severity, providing a novel framework for statistically robust clinical/translational studies of new treatments to reduce the risk of post-traumatic arthritis.

描述(由申请人提供)：这项拟议的研究旨在推进对持续关节内粉碎性骨折患者的评估的创新方法。创伤后骨关节炎(PTOA)是一种晚期并发症，具有终身的发病率和残疾，其风险与伴随这些骨折的关节创伤的强度有关。目前评估关节损伤严重程度的方法是有限的、不可重复性的，而且通常是定性的，这阻碍了对旨在避免PTOA的新治疗方法的评估。在可以客观地测量最初损伤的严重程度之前，它将仍然是一个严重的混乱，阻碍有意义的调查。这项拟议工作的全球目标是建立物理基础的、非侵入性的技术来量化关节内骨折的严重程度。CT测量的给定骨折所消耗的机械能提供了关节机械损伤的指标。它们没有考虑到碎片的定位，或碎片移位和扩散，这是反映PTOA风险的关键因素，因为这需要目前无法获得分散的碎片在完整的骨骼中最初占据的位置的知识。推断这些信息实际上需要解决一个三维(3-D)难题，这项任务最近开始出现合适的计算算法。这一新能力有可能极大地推动评估关节内粉碎性骨折的方式，促进旨在恢复高危关节组织健康的新治疗方法的研究(主要是生物治疗)。将追求两个特定的目标来促进这种用途的3-D谜题解决方法。具体目标1是在由骨替代材料加工并包裹在软组织替代材料中的测试样本中产生典型的骨折碎裂。碎片体积和表面数据将通过CT扫描获得(预期临床使用)，碎片处于自发移位/散布位置，重复表面数据将从随后的单个碎片激光扫描中获得(黄金标准)。根据这些数据，将确定骨折碎片分割的准确性，以及在重建已知的骨折前样本几何形状时的三维难题求解的准确性。具体目标2是从现有的一系列胫骨平台骨折病例中获得三维谜题解决方案和相关的骨折严重程度指数，这些病例的三到五年的结果数据将可用。骨折严重程度指标将与严重程度的临床等级排序相关，进而与PTOA的临床发生率和功能结果指标相关。 与公共卫生相关：遭受严重肢体创伤的患者，骨骼高度碎裂，骨折延伸到踝关节或膝盖等关节，预后通常很差，最终导致关节炎是常见的致残结果。由于缺乏骨折严重程度的客观测量，外科医生目前依靠主观印象来指导这些患者的治疗，阻碍了预防创伤后关节炎的进展。三维解谜方法产生了新的、客观的关节骨折严重程度测量方法，为统计上可靠的临床/翻译研究减少创伤后关节炎风险的新方法提供了一个新的框架。