Biomechanical Analysis in Strabismus Surgery

斜视手术中的生物力学分析

• 批准号: 8258712
• 负责人: JOSEPH Louis DEMER
• 金额: $ 58.26万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-01-06 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8258712
• 关键词: 3-Dimensional; Acceleration; Achievement; Acute; Adult; Affect; Anatomy; Animals; Behavior; Biomechanics; Blindness; Brain; Brain Diseases; Brain Pathology; Brain Stem; Cells; Child; Chronic; Clinical; Complement; Computers; Connective Tissue; Coupled; Cranial nerve diseases; Data; Denervation; Diagnosis; Diagnostic Specificity; Diplopia; Disease; Elasticity; Engineering; Esotropia; Exhibits; Eye; Eye diseases; Finite Element Analysis; Head; Health; Human; Imagery; Individual; Intramuscular; Lateral; Life; Ligaments; Magnetic Resonance Imaging; Mechanics; Microanatomy; Microscopic; Modeling; Motion; Muscle; Muscle denervation procedure; Muscle function; Myopathy; Nerve; Ocular orbit; Operative Surgical Procedures; Paralysed; Patients; Physiological; Postoperative Period; Primates; Property; Relative (related person); Resolution; Role; Saccades; Speed; Strabismus; Stretching; Surgical Pathology; Syndrome; Techniques; Testing; Time; Tissue Sample; Tissues; abducens nerve; age related; base; cell motility; gaze; human tissue; improved; kinematics; morphometry; muscle strength; nanoscale; nerve supply; nervous system disorder; neuroregulation; nonhuman primate; novel; oculomotor; older patient; orbit muscle; public health relevance; response; success; volunteer

DESCRIPTION (provided by applicant): We propose four interrelated subprojects to define the biomechanics of the eye rotating (extraocular) muscles (EOMs) and other tissues in health and disease, understand novel EOM actions, and characterize effects of nerve damage to EOMs. This effort is to improve diagnosis and surgical treatment of strabismus, which is misalignment of the directions of the two eyes. Aim I will clarify the role of connective tissue degeneration in common forms of strabismus that develop in adults, testing the hypothesis that some forms of acquired horizontal or vertical double vision are caused, not by brain or nerve disease as widely supposed now, but instead by connective tissue degeneration that alters EOM paths. Such degeneration would not signify neurological disease but may be corrected by surgery. Aim II will characterize effects of nerve damage on EOMs in common clinical strabismus syndromes treated by EOM surgery, including palsy of the trochlear, oculomotor, and abducens nerves, to clarify the time course and extent of mechanical changes such as EOM thinning and stretching, and possibly regrowth of damaged nerves or substitution by other nerves. Parallel studies will validate magnetic resonance imaging (MRI) of the eye sockets by comparison with microscopic changes to improve diagnostic specificity. Aim III will test a new hypothesis that nerve control selective for individual parts of EOMs permits them to have important mechanical actions not currently considered in their physiological repertoire, and hence confounding to clinicians who treat strabismus. Microscopic studies of intramuscular nerve distributions will be complemented by functional studies using structural and motion encoded MRI during binocular gaze changes, convergence to near targets, and head tilting to determine the influence of selective EOM actions on binocular alignment. Aim IV will characterize and model behavior of orbital fibromuscular tissues, using the modern mechanical engineering technique of finite element analysis (FEA) to integrate data on EOM and connective tissue properties obtained using novel techniques of minimal indentation, and dual-mode loading at lifelike speed and acceleration. Biomechanical testing will test the potential for selective compartmental action in EOMs. FEA based on accurate biomechanical data will be compared using 3-dimensional computer visualization with pre- and post-operative MRI to understand and improve surgical treatment of double vision caused by connective tissue degeneration. PUBLIC HEALTH RELEVANCE: Strabismus is a common clinical disorder in which misalignment of the eyes can cause double vision in adults, and visual loss in children. Strabismus is often treated by surgical manipulation of mechanical properties of muscles and connective tissues in the eye socket. Improved understanding of mechanical properties and nerve control of eye socket tissues will improve the diagnosis of eye and brain diseases, and enhance the success of strabismus surgery.

描述（由申请人提供）：我们提出了四个相互关联的子项目，以定义眼旋转（眼外）肌（EOMs）和其他组织在健康和疾病中的生物力学，了解新的EOM行为，并表征神经损伤对EOMs的影响。这一努力是为了提高斜视的诊断和手术治疗，这是两眼的方向不对准。目的：我将阐明结缔组织变性在成人常见斜视中的作用，验证以下假设：某些形式的获得性水平或垂直双重视力不是由现在普遍认为的大脑或神经疾病引起的，而是由改变EOM路径的结缔组织变性引起的。这种退化并不意味着神经系统疾病，但可以通过手术纠正。Aim II将描述经EOM手术治疗的常见临床斜视综合征（包括滑车、动眼神经和外展神经麻痹）中神经损伤对EOM的影响，以阐明EOM变薄和拉伸等力学变化的时间过程和程度，以及受损神经可能的再生或被其他神经替代。平行研究将验证眼窝的磁共振成像（MRI）与显微镜变化的比较，以提高诊断特异性。Aim III将测试一种新的假设，即eom的各个部分的神经控制选择性允许它们具有重要的机械作用，目前在其生理功能中尚未考虑到，因此混淆了治疗斜视的临床医生。肌内神经分布的显微研究将辅以双目注视变化、向近目标趋同和头部倾斜期间的结构和运动编码MRI功能研究，以确定选择性EOM动作对双眼对准的影响。目的IV将描述和模拟眼眶纤维肌肉组织的行为，利用有限元分析（FEA）的现代机械工程技术来整合EOM和结缔组织特性的数据，这些数据是通过最小压痕的新技术获得的，并在逼真的速度和加速度下进行双模加载。生物力学测试将测试EOMs中选择性区室作用的潜力。将基于精确生物力学数据的有限元分析与术前、术后MRI进行三维计算机可视化比较，了解并改进结缔组织变性所致复视的手术治疗。