Quantifying Injury Severity to Assess the Risk of Post-Traumatic Osteoarthritis

项目摘要：拟议的研究旨在令人信服地建立新的物理基础上的非 侵入性技术用于量化关节内骨折的严重程度。创伤后骨关节炎(PTOA)是 一种频繁的、通常是早期的治疗并发症，具有相当大的终生发病率和残疾。这个 关节内骨折的初始关节创伤强度是导致关节内骨折的重要因素。 PTOA。对移位和碎裂的关节表面进行手术复位的干预措施 经过几十年的发展和完善。然而，对于一些伤病来说，PTOA似乎仍然是不可避免的， 外科手术的进步不太可能明显改变预后。关于生物体的知识知之甚少 在这些损伤后不久关节内的工作过程，或它们如何将关节损伤与最终 PTOA。新提出的生物干预措施需要进一步的科学评估，但这将需要 合理地对患者队列进行分层，并进行足够多的研究，以产生统计上可靠的结果 调查结果。为了对患者进行分层，必须客观地测量初始损伤的严重程度，以免它仍然是一个 这将继续阻碍有意义的调查。我们已经开发出了 经过验证的支持技术，可在临床环境中测量骨折严重程度。目标1：我们将扩大和 加快这一基于CT的方法，以更好地评估关节骨折，实施新技术 评估关节碎裂、碎片扩散和软组织损伤。目标2：在未来的多 中心研究，我们将把快速损伤严重程度度量与一种新的基于计算机的方法相关联，以 不断对排序案例进行严重程度排名，我们将这两个严重程度度量与 PTOA的发展。目的3：我们将在一项关于胫骨的前瞻性研究中检测受伤踝关节的滑液。 对四肢骨折患者，收集有关关节损伤和康复的描述性数据。 伤病期。这些生物标记物将与快速损伤严重程度指标相关联，并且每个 TURN将与患者的预后相关。 与公共健康相关：骨折延伸至关节的患者，如 像脚踝或膝盖一样，预后通常很差，最终导致关节炎是一种常见的致残结果。 外科医生依靠主观经验来指导关节骨折的治疗，这在很大程度上 阻碍进步。这项研究将从根本上提供新的客观、非侵入性的测量方法 关节骨折损伤严重程度。这些方法本身将具有重要的临床意义， 并为统计稳健的临床/翻译研究提供了一个新的框架，以降低 PTOA。

PROJECT SUMMARY: The proposed research aims to convincingly establish new physically-grounded non- invasive techniques to quantify the severity of intra-articular fractures. Post-traumatic osteoarthritis (PTOA) is a frequent and often early complication of treatment, with substantial lifelong morbidity and disability. The intensity of the initial joint trauma in intra-articular fractures is a critically important factor in the etiology of PTOA. Interventions to surgically reduce the displaced and fragmented articular surface have been developed and refined over decades. Yet, for some injuries, PTOA remains seemingly inevitable, with surgical advances unlikely to appreciably change the prognosis. Little is known regarding the biological processes at work within the joint shortly following these injuries, or how they link joint injury to eventual PTOA. Newly proposed biologic interventions warrant further scientific evaluation, but this will require that patient cohorts be reasonably stratified and studied in large enough numbers to yield statistically robust findings. To stratify patients, the severity of the initial injury must be objectively measured, lest it remain a substantial confounder that will continue to preclude meaningful investigation. We have developed and validated enabling technology to measure fracture severity in a clinical setting. AIM 1: We will extend and expedite this CT-based methodology to better assess articular fractures, implementing new techniques to assess articular fragmentation, fragment dispersal, and the soft tissue injury. AIM 2: In a prospective multi- center study we will correlate the expedited injury severity metric with a new computer-based method to continually rank order cases for severity, and we will correlate both of these severity metrics with the development of PTOA. AIM 3: We will assay synovial fluid from injured ankles in a prospective study of tibial plafond fracture patients, to gather descriptive data regarding joint damage and recovery in the early post- injury period. These biologic markers will be correlated with the expedited injury severity metric, and each in turn will be correlated with patient outcomes. RELEVANCE TO PUBLIC HEALTH: Patients who sustain fractures that extend into an articular joint, such as the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling result. Surgeons rely upon subjective empirical experience to guide articular fracture treatment, and this greatly hinders progress. This study will provide fundamentally new objective non-invasive methods to measure articular fracture injury severity. These methods will have important clinical implications in their own right, and provide a novel framework for statistically robust clinical/translational studies to reduce the risk of PTOA.