Biomechanical Analysis in Strabismus Surgery

斜视手术中的生物力学分析

• 批准号: 8452106
• 负责人: JOSEPH Louis DEMER
• 金额: $ 55.35万
• 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/8452106
• 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.

描述（由申请人提供）：我们提出了四个相互关联的子项目来定义健康和疾病中眼睛旋转（眼外）肌肉（EOM）和其他组织的生物力学，了解新的 EOM 作用，并表征神经损伤对 EOM 的影响。这项努力是为了改善斜视的诊断和手术治疗，斜视是两只眼睛的方向错位。目的 我将阐明结缔组织变性在成人常见斜视形式中的作用，检验以下假设：某些形式的获得性水平或垂直复视不是由现在广泛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。目标 II 将描述 EOM 手术治疗的常见临床斜视综合征中神经损伤对 EOM 的影响，包括滑车神经、动眼神经和外展神经麻痹，以阐明机械变化的时间过程和程度，例如 EOM 变薄和拉伸，以及受损神经可能的再生或被其他神经替代。并行研究将通过与微观变化进行比较来验证眼窝的磁共振成像（MRI），以提高诊断特异性。目标 III 将测试一个新的假设，即对 EOM 各个部分的选择性神经控制允许它们具有目前未在其生理功能中考虑的重要机械动作，从而使治疗斜视的临床医生感到困惑。肌内神经分布的显微研究将通过在双眼注视变化、会聚到近目标以及头部倾斜期间使用结构和运动编码 MRI 的功能研究来补充，以确定选择性 EOM 动作对双眼对准的影响。 Aim IV 将使用现代机械工程有限元分析 (FEA) 技术来表征和模拟眼眶纤维肌肉组织的行为，整合使用最小压痕新技术以及逼真的速度和加速度双模式加载获得的 EOM 和结缔组织特性数据。生物力学测试将测试 EOM 选择性隔室作用的潜力。基于精确生物力学数据的有限元分析将使用 3 维计算机可视化与术前和术后 MRI 进行比较，以了解和改进结缔组织变性引起的复视的手术治疗。