Muscle-Tendon Structure and Function Following Chronic Limb-Shortening Imposed by Proximal Row Carpectomy

近行腕骨切除术造成慢性肢体缩短后的肌腱结构和功能

• 批准号: 9910726
• 负责人: Amy Adkins
• 金额: $ 4.07万
• 依托单位: NORTHWESTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9910726
• 关键词: 3D ultrasound; Affect; American; Animal Model; Architecture; Area; Articular Range of Motion; Atrophic; Biomechanics; Chronic; Clinical; Complication; Contralateral; Data; Degenerative polyarthritis; Development; Distal; Educational process of instructing; Elbow; Excision; Exhibits; Failure; Fascicle; Fiber; Flexor; Forearm; Generations; Goals; Gold; Hand; Hand Strength; Hand functions; Hip region structure; Human; Imaging Techniques; Immobilization; Impairment; Individual; Isometric Exercise; Joints; Knee; Left; Length; Life; Limb structure; Link; Measures; Medical Imaging; Mentors; Methods; Muscle; Muscle function; Muscular Atrophy; Operative Surgical Procedures; Outcome; Pain; Pain-Free; Physiological; Positioning Attribute; Postoperative Period; Procedures; Protocols documentation; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Research; Research Personnel; Sarcomeres; Series; Side; Surgeon; Tendon structure; Testing; Time; Torque; Training; Ultrasonography; Wrist; Writing; arm; base; bone; career; carpus bone; chronic stroke; experience; grasp; improved; improved functioning; in vivo imaging; innovation; joint stiffness; microendoscopy; muscular structure; novel; pain relief; second harmonic; skills; standard of care; wrist function

PROJECT SUMMARY/ABSTRACT. Most cases of wrist osteoarthritis (OA) are a form of degenerative arthritis associated with severe pain. Because a functional, pain free wrist is essential for a functional hand, wrist OA precludes many tasks of everyday life (i.e. opening a door, carrying groceries). One of the most common surgical treatments for severe wrist OA, proximal row carpectomy (PRC), involves removal of the entire proximal row of carpal bones, shortening the forearm-to-hand length. This procedure is successful in relieving pain and improving function relative to an untreated wrist. However, compared to a healthy wrist, PRC often yields decreased range of motion and loss of grip strength. The cause of these functional deficits following PRC is not understood. Following PRC, forearm-to-hand length is decreased without concomitant surgical shortening of muscle-tendon units. As a result, surgeons have an anecdotal assumption that post-PRC deficits arise, in part, because the muscle-tendon units are relatively long, or “slackened” due to the surgery. However, studies in animal models and our preliminary data in humans suggest that, when maintained in a shortened position for an extended time, muscles lose sarcomeres in series, resulting in atrophy and increased passive stiffness. Based on these objective studies, we hypothesize that the limb shortening imposed by PRC results in decreased serial sarcomere number and muscle volume, decreasing active muscle force-generating capacity. We will test our hypothesis by implementing novel, in vivo imaging techniques in both limbs of individuals with unilateral PRCs. We will quantify interlimb differences in serial sarcomere number (Aim 1) and muscle volume (Aim 2) and determine their contributions to functional deficits. We will measure sarcomere length via second harmonic generation microendoscopy, fascicle length using extended field-of-view-ultrasound, and both tendon length and muscle volume using 3D ultrasound. From these data, we will identify chronic differences in muscle structure following PRC limb shortening by calculating serial sarcomere number (optimal fascicle length) and physiological cross-sectional area. Quantitative biomechanical measures of muscle function and clinical impairment, including passive joint torques and maximum isometric grip force, will also be assessed. Quantifying muscle-tendon structural adaptations to this chronic limb shortening will inform the development of more effective rehabilitation protocols and surgical interventions for individuals with severe wrist OA. The proposed research will develop experimental skills necessary to link muscle structural changes to clinical deficits. In addition, training on surgical and rehabilitation treatments, effective teaching and mentoring, collaborating and communicating with scientific and clinical audiences, and clear, succinct scientific writing skills are planned. This training and research will provide the necessary experiences and skills to pursue a career as an independent researcher in an academic setting.

项目总结/摘要。 大多数腕关节骨关节炎（OA）是一种与严重疼痛相关的退行性关节炎。 因为功能性的、无疼痛的手腕对于功能性的手是必不可少的，所以手腕OA排除了许多任务， 日常生活（例如开门、搬运杂货）。对于严重的癌症，最常见的手术治疗之一是 腕关节OA，近侧行腕骨切除术（PRC），包括移除整个近侧行腕骨， 缩短前臂到手的长度。这种手术在缓解疼痛和改善功能方面是成功的 相对于未经治疗的手腕。然而，与健康的手腕相比，PRC通常产生减小的范围。 运动和握力的丧失。PRC后这些功能缺陷的原因尚不清楚。 PRC后，前臂到手的长度减少，而没有伴随手术缩短 肌腱单位因此，外科医生有一个轶事假设，即后中华人民共和国赤字出现，部分， 因为肌肉-肌腱单元相对较长，或者由于手术而“松弛”。然而，研究 动物模型和我们在人类中的初步数据表明，当保持在缩短的位置， 随着时间的延长，肌肉会连续失去肌节，导致萎缩和被动僵硬。 基于这些客观研究，我们假设PRC造成的肢体缩短导致 减少连续肌节数量和肌肉体积，降低主动肌力产生能力。 我们将通过在患有糖尿病的个体的四肢中实施新颖的体内成像技术来测试我们的假设。 单方面的PRC。我们将量化连续肌节数（Aim 1）和肌肉体积的肢体间差异 (Aim 2）并确定其对功能缺陷的贡献。我们将测量肌节长度通过秒 谐波发生显微内窥镜检查，使用扩展视野超声测量肌束长度， 使用3D超声测量长度和肌肉体积。从这些数据中，我们将确定肌肉的慢性差异， 通过计算连续肌节数（最佳肌束长度）， 生理横截面积。肌肉功能的定量生物力学测量与临床 还将评估损伤，包括被动关节扭矩和最大等长握力。 量化肌肉肌腱结构适应这种慢性肢体缩短将告知发展， 更有效的康复方案和手术干预的个人与严重的手腕骨关节炎。 拟议的研究将开发必要的实验技能，将肌肉结构的变化与 临床缺陷此外，手术和康复治疗培训、有效的教学和指导， 与科学和临床受众合作和沟通，以及清晰、简洁的科学写作 技能是有计划的。这种培训和研究将提供必要的经验和技能，以追求一个 在学术环境中作为独立研究员的职业生涯。