The Morphology and Characteristics of Hallux Rigidus

拇强直的形态及特征

• 批准号: 9892891
• 负责人: Joseph Iaquinto
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892891
• 关键词: 3-Dimensional; Age; Age-Years; Agreement; Algorithms; Anatomy; Appearance; Area; Arthritis; Articular Range of Motion; Bone Spur; Cartilage; Characteristics; Classification; Classification Scheme; Clinical; Communities; Complex; Computer Analysis; Conflict (Psychology); Consensus; Data; Degenerative polyarthritis; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic radiologic examination; Disease; Disease Progression; Dorsal; Early treatment; Engineering; Environment; Evaluation; Exhibits; Future; Gait; Geometry; Goals; Hallux Rigidus; Head; Healthcare Systems; Hybrids; Image; Interphalangeal joint of toe; Joints; Judgment; Knowledge; Lateral; Lead; Link; Literature; Manuals; Measurement; Measures; Metatarsal bone structure; Metatarsophalangeal joint structure; Methods; Modeling; Morphology; Motion; Pain; Patient Care; Patients; Pattern; Performance; Persons; Pharmacologic Substance; Physical therapy; Polishes; Population; Prevalence; Quality of life; Radial; Reporting; Research; Roentgen Rays; Scheme; Selection for Treatments; Severities; Shapes; Surface; System; Toes; Translating; Veterans; Visit; Walking; Weight-Bearing state; Work; X-Ray Computed Tomography; associated symptom; bone; design; diagnosis standard; digital; end stage disease; experience; follow-up; foot; improved; insight; joint function; joint inflammation; metatarsal region; novel; pain relief; patient population; programs; recruit; sound; three-dimensional visualization; user-friendly

Hallux Rigidus (HR) is the end stage of great toe osteoarthritis, which is a degenerative joint disease that effects approximately 1 in 40 people over the age of 50. The development of arthritis in the first metatarsophalangeal joint (MTPJ) is painful, effecting quality of life, reducing mobility and altering gait patterns. Early treatments for pain relief include physical therapy, pharmaceuticals and modified footwear. If these treatments fail to provide relief and the arthritis progresses, joint function is largely lost (hence rigidus for end-stage disease progression). Concerning veterans, from 2008-2017, nationwide data from the Veterans Healthcare System yielded 87,798 patient visits for HR (1,897 in that same period for the VA Puget Sound Healthcare System), and the number of patient visits has consistently increased year to year from 9,396 visits nationwide in 2008 to 22,180 visits in 2017. In order to properly match veteran HR patients with proper treatment, the stage of the disease progression needs to be properly classified. The most common classification systems use radiographic findings. Typically, AP and lateral X-ray views are evaluated for joint space (reduced space indicates lost cartilage), osteophytes (and indicator of arthritis), and joint shape (as HR patients preferentially lose cartilage and gain osteophytes on the dorsal surface). Yet the exact features evaluated, and how they are considered, is not standardized. This issue is further complicated by some grading schemes which blend clinical findings of range of motion and pain, into the already-complex field of radiographic features. Finally, while 2D X-rays are the standard for diagnosis, HR is a complex 3D disease and it has been hypothesized that certain bone positional (metatarsus primus elevatus) and morphological (articular surface shape) may be correlated with HR and possibly predispose patients to develop HR. Such measurements can be difficult to realize on 2D X-ray, and using manual and subjective measures. Therefore we propose to utilize existing weight-bearing CT data from control feet and obtain similar data from fifteen HR subjects. We will use this imaging data to evaluate the Intraclass Correlation associated with some of the more common HR classification schemes (Aim 1). This will allow us to establish reliability measures for the existing methods of clinically grading hallux rigidus, this will aid to inform the clinical community of the reliability of currently practiced diagnostic methods—which have a direct impact on treatment selection and patient care. We will also use our prior experience in evaluating 3D bony anatomy to semi-automate a suite of first ray positional (joint spacing, first metatarsal alignment, metatarsus primus elevatus) and morphological (sagittal plane metatarsal head curvature) features, which are suspected to have a correlation to HR (Aim 2). One of the greatest challenges associated with this work relate to developing a user-friendly environment by which clinicians can rapidly select bone features, which will algorithmically determined measurements for immediate reporting. To this end we will hire a research engineer with specific background in developing user interfaces and 3D digital object manipulation. This specialization is designed to generate a well-documented and polished analysis program which can be readily learned by clinicians. The other significant challenge is in determining the potential benefit of our proposed additional measurements in either enhancing or replacing the current classifications schemes. The benefit of these measurements will support our additional goal to lay the groundwork for either enhancing a current classification scheme (potentially by adding an additional measure) or developing a new classification scheme (via a new slate of semi-automated measurements) two project areas which this study will develop preliminary data for follow up with a future Merit Review.

Hallux origidus（HR）是大脚趾骨关节炎的终点，这是一种影响的关节疾病，影响 大约40岁以上的40人中有1人。第一个ta左拨养生中关节炎的发展 关节（MTPJ）是痛苦，有效的生活质量，降低了移动性和步态模式的改变。早期治疗 缓解疼痛包括物理疗法，药物和改良的鞋类。如果这些治疗未能提供 浮雕和关节炎的进展，关节功能在很大程度上消失了（因此，末期疾病进展）。 关于退伍军人，从2008年至2017年，来自退伍军人医疗保健系统的全国性数据产生了87,798 患者访问人力资源（同一时期1,897，VA Puget Sound Healthcare系统）和数量 患者的访问始终逐年增加，从2008年全国的9,396次访问到2017年的22,180次访问。 为了适当与经验丰富的人力资源患者进行适当治疗，疾病进展的阶段需要 正确分类。 最常见的分类系统使用影像学发现。通常，AP和横向X射线视图是 评估关节空间（缩小空间表示失去软骨），骨植物（和关节炎的指标）和 关节形状（HR患者优先失去软骨并在背面上造成骨属）。但是 评估的确切功能及其被考虑的方式尚未标准化。这个问题更加复杂 一些分级方案，将运动范围和疼痛范围临床发现融合到已经复杂的领域 射线照相特征。最后，虽然2D X射线是诊断的标准，但HR是一种复杂的3D疾病 并且已经假设某些骨位置（Metatars primus leveratus）和形态学 （关节表面形状）可能与HR和可能的患者相关以发展HR。这样的 在2D X射线以及使用手动和主观测量值的测量可能很难实现。 因此，我们建议从控制脚上利用现有的承重CT数据，并从中获取相似的数据 15个人力资源主体。我们将使用这些成像数据来评估与某些相关的类内相关性 HR分类方案更为常见（AIM 1）。这将使我们能够为 现有的临床分级术方法的方法，这将有助于将可靠性告知临床社区 当前实践的诊断方法对治疗选择和患者护理有直接影响。 我们还将利用我们先前的经验评估3D骨解剖结构，以半自动层 位置（关节间距，第一个meta骨比对，metatars primus leveratus）和形态学（矢状 平面metaTARSARSARTARS曲率）特征，怀疑与人力资源有相关性（AIM 2）。 与这项工作相关的最大挑战之一与通过用户友好环境相关 哪些临床医生可以快速选择骨骼特征，该特征将通过算法确定的测量值 立即报告。为此，我们将聘请具有特定背景的研究工程师开发用户 接口和3D数字对象操纵。该专业旨在生成有据可查的文献和 临床医生可以很容易学到的抛光分析计划。另一个重大挑战是 确定我们提出的其他测量在增强或替换的潜在益处 当前的分类方案。这些测量的好处将支持我们实现的其他目标 用于增强当前分类方案的基础（可能通过添加额外的措施） 或制定新的分类方案（通过半自动测量的新板）两个项目领域 这项研究将开发初步数据，以进行后续审查。