Improving the Detection, Classification and Treatment of Misaligned Arthritic Ankles

改善脚踝关节炎错位的检测、分类和治疗

• 批准号: 10642692
• 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: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10642692
• 关键词: 3-Dimensional; Affect; Ankle; Ankle Fracture; Ankle Injuries; Arthritis; Award; Cartilage; Categories; Classification; Climacteric; Clinical; Clinical Management; Compensation; Congenital Abnormality; Data; Degenerative polyarthritis; Detection; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Disease; Exhibits; Financial Hardship; Fluoroscopy; Foot Injuries; Fostering; Fracture; Gait; Goals; High Prevalence; Image; Injury; Joints; K-Series Research Career Programs; Knowledge; Lateral; Literature; Measurement; Measures; Medial; Methodology; Methods; Motion; Movement; Nature; Optics; Outcome; Patients; Population; Prevention; Quality of life; Research; Roentgen Rays; STEM career; Secondary to; Services; Shoes; Sprain; System; Talus; Technology; Time; Translating; Trauma; Traumatic injury; Veterans; Walking; Weight-Bearing state; Work; X-Ray Computed Tomography; ankle joint; bone geometry; clinical diagnosis; clinical diagnostics; clinically actionable; diagnostic accuracy; diagnostic tool; effectiveness testing; experience; foot; imaging approach; imaging system; improved; kinematics; ligament injury; military service; military veteran; new technology; novel; patient population; radiological imaging; recruit; restoration; stem; study population

Ankle osteoarthritis (OA) is a debilitating and mobility limiting condition. It can commonly stem from the result of a traumatic injury – such trauma has a high prevalence in military service. If cartilage is not severely damaged in that trauma, the stability and alignment of the joint may be. Over time, an unstable or misaligned ankle joint can experience abnormal rates of cartilage wear and tear due to aberrant kinematics. While OA may take decades to develop, the resulting arthritic state from this trauma will ultimately require ankle replacement or fusion, consequences with a tremendous financial burden and quality of life impact. With regards to alignment, particularly in the coronal plane, current clinical diagnosis relies on static X- ray of the ankle joint. Static images may not indicate dynamic misalignment during gait. Further, the effect of wedged insoles, a potential conservative treatment, on the restoration of ankle function is undocumented. This proposal aims to use biplane fluoroscopy, an X-ray based dynamic imaging approach, to measure ankle kinematics in OA subjects (with varus, neutral and valgus ankle alignment) and controls. With this method, tibio-talar kinematics during gait can be measured. Furthermore, subjects classified as neutral from their static radiograph, but that exhibit ankle varus or valgus alignment during gait, will be identified. Improving the accuracy of a diagnostic outcome provides a patient group with additional avenues for treatment. We will investigate correlations between our 3D kinematics and clinical 2D imaging – to the benefit of clinical diagnostics. We will also be able to measure the effect of wedged insoles on the restoration of ankle function. With this in mind, the following aims and methodology are proposed. Specific Aim 1: To investigate ankle kinematics in controls and subjects with OA. In support of Specific Aim 1, 90 ankle OA subjects will be recruited (30 each of varus, neutral or valgus aligned ankles). We will also recruit 20 control subjects. Subjects will receive CT scans of their feet to quantify bone geometry (a step necessary for biplane fluoroscopy). Subjects will then be imaged in the biplane system during gait trials and while wearing neutral study shoes. This will yield tibio-talar kinematics during gait for these populations. Specific Aim 2: To identify dynamically misaligned ankles in OA subjects who are currently classified as neutrally aligned using static analysis. We will compare the static X-ray and the gait kinematics of OA subjects, particularly those with clinically determined neutral alignment. We will determine what proportion of neutral OA subjects actually exhibit misalignment during gait and are thus improperly categorized. We will also re-create 2D clinical X-ray views from our 3D data in an attempt to translate our improvement (with 3D fluoroscopy) to more accurately classify alignment to clinical 2D diagnostics. Specific Aim 3: To evaluate the potential of lateral or medial wedging to restore alignment in misaligned ankle OA subjects. OA subjects will be imaged wearing shoes with wedged insoles which correspond to their type of misalignment. Neutral OA subjects, who demonstrate misalignment during gait, will be recalled for a wedged insole session. This yields conservative treatment kinematics. This study will generate baseline data describing the kinematics of control and ankle OA subjects. This data is not currently available in the literature, and represents a novel contribution to the field. Second, this proposal determines how accurate current 2D X-ray methods are at detecting dynamic misalignment. This information can inform clinicians about the accuracy of their diagnostic tools, and may lead to improvements. Third, this proposal will generate data to evaluate the utility of wedged insoles for the conservative management of ankle misalignment. In Summary, this study has immediate impact potential on the diagnosis and treatment of ankle OA. Last, there are numerous additional avenues of classification, diagnostic, and preventative research for the benefit of the veterans which will stem from this Career Development Award.

踝骨关节炎 (OA) 是一种使人衰弱且活动受限的疾病。它通常可以源于 外伤的结果——这种外伤在兵役中很常见。如果软骨不是 在该创伤中严重受损，关节的稳定性和对准可能会受到影响。随着时间的推移，不稳定或 由于异常的运动学，未对准的踝关节可能会出现异常的软骨磨损率。 虽然 OA 可能需要几十年的时间才能形成，但这种创伤导致的关节炎状态最终将需要 踝关节置换或融合，后果是巨大的经济负担和生活质量影响。 关于对准，特别是在冠状平面中，当前的临床诊断依赖于静态 X- 踝关节的射线。静态图像可能无法指示步态期间的动态错位。进一步地，效果 楔形鞋垫是一种潜在的保守治疗方法，对于恢复踝关节功能尚无文献记载。 该提案旨在使用双平面透视（一种基于 X 射线的动态成像方法）来测量 OA 受试者的踝关节运动学（内翻、中立和外翻踝关节排列）和对照。有了这个 方法，可以测量步态期间的胫距运动学。此外，被归类为中立的受试者 他们的静态射线照片，但在步态中表现出踝关节内翻或外翻对齐，将被识别。 提高诊断结果的准确性为患者群体提供了额外的途径 治疗。我们将研究 3D 运动学与临床 2D 成像之间的相关性 – 从而受益 的临床诊断。我们还将能够测量楔形鞋垫对脚踝恢复的影响 功能。考虑到这一点，提出以下目标和方法。 具体目标 1：研究对照组和 OA 受试者的踝关节运动学。在 支持具体目标 1，将招募 90 名踝关节 OA 受试者（内翻、中立或外翻各 30 名） 脚踝）。我们还将招募 20 名对照受试者。受试者将接受足部 CT 扫描以量化骨量 几何形状（双平面透视所需的步骤）。然后，受试者将在双翼飞机系统中成像 步态试验以及穿着中性学习鞋时。这将在步态期间产生胫距运动学 人口。具体目标 2：识别 OA 受试者的动态脚踝错位 目前使用静态分析将其分类为中立对齐。我们将比较静态 X 射线和 OA 受试者的步态运动学，特别是那些临床确定的中性排列的受试者。我们将 确定中性 OA 受试者在步态中实际上表现出错位的比例，因此 分类不当。我们还将根据 3D 数据重新创建 2D 临床 X 射线视图，试图 将我们的改进（通过 3D 透视）转化为更准确地对临床 2D 对齐进行分类 诊断。具体目标 3：评估外侧或内侧楔入恢复的潜力 踝关节未对准 OA 受试者的对准。 OA 受试者将穿着楔形鞋进行成像 与其错位类型相对应的鞋垫。中立 OA 受试者，表现出错位 在步态期间，将被召回以进行楔形鞋垫训练。这产生了保守的治疗运动学。 这项研究将生成描述对照受试者和踝关节 OA 受试者运动学的基线数据。这 目前文献中还没有数据，但代表了对该领域的新颖贡献。二、这个 该提案确定了当前 2D X 射线方法在检测动态未对准方面的准确度。这 信息可以让临床医生了解其诊断工具的准确性，并可能带来改进。 第三，该提案将生成数据来评估楔形鞋垫对于保守派的效用 踝关节错位的管理。总之，这项研究对诊断具有直接影响潜力 以及踝关节骨关节炎的治疗。最后，还有许多其他的分类、诊断和诊断途径。 为了退伍军人的利益而进行的预防性研究将源自该职业发展奖。