Muscle Geometry and its Influence on Function in Patients with Developmental Dysplasia of the Hip

发育性髋关节发育不良患者的肌肉几何形状及其对功能的影响

• 批准号: 9888331
• 负责人: Michael D Harris
• 金额: $ 11.08万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9888331
• 关键词: 3-Dimensional; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Biomechanics; Biomedical Engineering; Bone structure; Clinical; Clinical Research; Data; Degenerative polyarthritis; Development; Development Plans; Diagnostic radiologic examination; Disease; Dysplasia; Ensure; Equilibrium; Etiology; Evaluation; Exercise; Femur; Generations; Geometry; Goals; Hip Osteoarthritis; Hip region structure; Individual; Intervention; Joints; Knowledge; Laboratories; Lateral; Lead; Lesion; Link; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Mentors; Modeling; Morphology; Motion; Movement; Muscle; Muscle Weakness; Muscle function; Musculoskeletal; Operative Surgical Procedures; Orthopedics; Pain; Patient Outcomes Assessments; Patient Selection; Patient-Focused Outcomes; Patients; Prevention; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Risk; Role; Severities; Shapes; Structure; Surgeon; Symptoms; Techniques; Testing; Three-dimensional analysis; Torque; Total Hip Replacement; Training; Treatment outcome; Validation; Work; acetabulum; arm; articular cartilage; bone; bone geometry; common symptom; improved; in vivo; joint injury; joint loading; meetings; muscle strength; muscular structure; novel; pain perception; pain score; pain symptom; pathomechanics; physical conditioning; physical therapist; preservation; rehabilitation strategy; restoration; skills; soft tissue; strength training; surgery outcome; symptomatology; treatment optimization; treatment strategy; young adult

PROJECT SUMMARY Developmental dysplasia of the hip (DDH) dramatically increases risk for early development of hip osteoarthritis (OA) in adolescents and young adults. In cases of DDH, abnormal development of the acetabulum (hip socket) and femur alter loading inside the joint, which can lead to painful acetabular labrum tears and articular cartilage lesions. Without correction, this joint damage progresses to OA and may require total joint replacement. Pain and physical limitation are common symptoms in patients with DDH. However, the presentation, intensity and combination of symptoms do not always correspond with radiographic signs of bony abnormalities or soft-tissue damage. Factors beyond bony structure, such as muscle function, likely contribute to symptom onset and altered joint loading, but the role of muscle in DDH pathomechanics is not well understood. This project will be the first to rigorously investigate the bone-muscle relationship as a factor in pathomechanics and symptomatology in patients with DDH. In Aim 1, we will use magnetic resonance imaging (MRI) and musculoskeletal models to compare hip muscle volumes, 3D muscle moment arms, and muscle strength between patients with DDH and control subjects. Aim 1 will provide the first 3D analyses of muscle geometry and moment arms in patients with DDH, and may elucidate relationships among muscle alterations, the severity of bony abnormalities, and muscle weakness. In Aim 2, we will use 3D motion capture to quantify hip movement and loading during activities of increasing biomechanical demand. Analyzing a range of activities that are common for our patients with DDH can identify mechanical distinctions between patients and control subjects that contribute to symptoms and joint damage. In Aim 3, we will identify translational relationships between our laboratory measures and clinical measures of patient reported outcomes (PROs). Identifying such relationships can establish novel links between important realms of patient evaluation – laboratory measurement and clinical research. Ultimately, we seek coordinated surgical and nonsurgical approaches that optimize joint loading and balance muscle use to improve treatment and delay OA for patients with DDH. Thus, in an exploratory Aim 4, we will compare bone-muscle geometry, strength, hip mechanics, and PROs one year after hip preservation surgery to pre-surgical values and determine the variables predictive of post-surgical outcomes. This proposal builds on the candidate's prior work in intra-articular mechanics and bone morphology and provides new training in MRI, strength testing, modeling, and clinical research with patients with hip disorders. The mentor team consists of physical therapists, orthopedic surgeons and bioengineers who are experts in muscle structure-function, MRI, OA development, and clinical intervention for DDH. Together, the results from this proposal will provide preliminary data for an R01 focused on key factors that affect patient outcomes after surgical and nonsurgical intervention for DDH.

项目摘要 发育性髋关节发育不良（DDH）显著增加了髋关节早期发育的风险 骨关节炎（OA）在青少年和年轻人。在DDH的情况下， 髋臼（髋关节窝）和股骨改变关节内的负荷，这可能导致髋臼唇疼痛 撕裂和关节软骨损伤如果不进行矫正，这种关节损伤会发展为OA， 全关节置换术疼痛和身体限制是DDH患者的常见症状。但 症状的表现、强度和组合并不总是与骨关节炎的放射学征象相对应。 异常或软组织损伤。骨骼结构以外的因素，例如肌肉功能，可能也有贡献 肌肉在DDH的病理机制中的作用尚不明确 明白该项目将是第一个严格调查骨骼-肌肉关系的因素， DDH患者的病理力学和病理学。在目标1中，我们将使用磁共振成像 (MRI)和肌肉骨骼模型，以比较臀部肌肉体积、3D肌肉力矩臂和肌肉 DDH患者和对照受试者之间的强度。Aim 1将提供肌肉的第一个3D分析 DDH患者的几何形状和力矩臂，并可能阐明肌肉改变之间的关系， 骨骼异常和肌肉无力的严重程度。在目标2中，我们将使用3D运动捕捉来量化 增加生物力学需求的活动过程中的髋关节运动和负荷。分析一系列 DDH患者常见的活动可以识别患者之间的机械差异， 控制导致症状和关节损伤的对象。在目标3中，我们将确定翻译 我们的实验室指标与患者报告结局（PRO）的临床指标之间的关系。 识别这种关系可以在患者评估的重要领域之间建立新的联系- 实验室测量和临床研究。最终，我们寻求协调的手术和非手术 优化关节负荷和平衡肌肉使用的方法，以改善治疗并延迟患者的OA 关于DDH因此，在探索性目标4中，我们将比较骨骼-肌肉几何形状、力量、髋关节力学， 将髋关节保留手术后一年的PRO值与术前值进行比较，并确定预测变量 手术后的结果。该建议建立在候选人先前在关节内力学方面的工作基础上， 骨形态学，并提供新的培训，在MRI，强度测试，建模和临床研究， 髋关节疾病患者。导师团队由物理治疗师、整形外科医生和 生物工程师是肌肉结构功能，MRI，OA开发和临床干预方面的专家， DDH总之，本提案的结果将为R 01提供关注关键因素的初步数据 影响DDH手术和非手术干预后患者结局的因素。