Quantifying Injury Severity to Assess the Risk of Post-Traumatic Osteoarthritis

量化损伤严重程度以评估创伤后骨关节炎的风险

• 批准号: 7677866
• 负责人: J LAWRENCE MARSH
• 金额: $ 25.29万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7677866
• 关键词: Ankle; Arthritis; Biological Assay; Biological Markers; Biological Process; Cartilage; Clinical; Collagen; Complication; Computers; Data; Degenerative polyarthritis; Development; Etiology; Fracture; Healed; Inflammation; Injury; Institution; Intervention; Invasive; Investigation; Joints; Knee; Link; Measurable; Measures; Mechanics; Methodology; Methods; Metric; Morbidity - disease rate; Numbers; Operative Surgical Procedures; Outcome; Patients; Physical assessment; Pilot Projects; Prospective Studies; Proteoglycan; Public Health; Recovery; Research; Risk; Scientific Evaluation; Series; Severities; Soft Tissue Injuries; Surface; Surgeon; Synovial Fluid; Techniques; Technology; Texture; Time; Trauma; Week; Work; base; bone; cohort; design; disability; experience; healing; indexing; injured; novel; outcome forecast; prospective; translational study

PROJECT SUMMARY: The proposed research aims to convincingly establish new physically-grounded non- invasive techniques to quantify the severity of intra-articular fractures. Post-traumatic osteoarthritis (PTOA) is a frequent and often early complication of treatment, with substantial lifelong morbidity and disability. The intensity of the initial joint trauma in intra-articular fractures is a critically important factor in the etiology of PTOA. Interventions to surgically reduce the displaced and fragmented articular surface have been developed and refined over decades. Yet, for some injuries, PTOA remains seemingly inevitable, with surgical advances unlikely to appreciably change the prognosis. Little is known regarding the biological processes at work within the joint shortly following these injuries, or how they link joint injury to eventual PTOA. Newly proposed biologic interventions warrant further scientific evaluation, but this will require that patient cohorts be reasonably stratified and studied in large enough numbers to yield statistically robust findings. To stratify patients, the severity of the initial injury must be objectively measured, lest it remain a substantial confounder that will continue to preclude meaningful investigation. We have developed and validated enabling technology to measure fracture severity in a clinical setting. AIM 1: We will extend and expedite this CT-based methodology to better assess articular fractures, implementing new techniques to assess articular fragmentation, fragment dispersal, and the soft tissue injury. AIM 2: In a prospective multi- center study we will correlate the expedited injury severity metric with a new computer-based method to continually rank order cases for severity, and we will correlate both of these severity metrics with the development of PTOA. AIM 3: We will assay synovial fluid from injured ankles in a prospective study of tibial plafond fracture patients, to gather descriptive data regarding joint damage and recovery in the early post- injury period. These biologic markers will be correlated with the expedited injury severity metric, and each in turn will be correlated with patient outcomes. RELEVANCE TO PUBLIC HEALTH: Patients who sustain fractures that extend into an articular joint, such as the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling result. Surgeons rely upon subjective empirical experience to guide articular fracture treatment, and this greatly hinders progress. This study will provide fundamentally new objective non-invasive methods to measure articular fracture injury severity. These methods will have important clinical implications in their own right, and provide a novel framework for statistically robust clinical/translational studies to reduce the risk of PTOA.

项目摘要：拟议的研究旨在令人信服地建立新的物理基础的非 量化关节内骨折严重程度的侵入性技术。创伤后骨关节炎（PTOA）是 一种常见的且往往是早期的治疗并发症，伴随着大量的终身发病率和残疾。的 在关节内骨折中，初始关节创伤的强度是关节内骨折的病因学中的一个至关重要的因素。 PTOA。手术复位移位和碎裂的关节面的干预措施， 经过几十年的发展和完善。然而，对于一些伤害，PTOA似乎仍然是不可避免的， 手术的进步不太可能明显改变预后。关于生物学知之甚少 这些损伤后不久关节内的工作过程，或者它们如何将关节损伤与最终的 PTOA。新提出的生物干预措施需要进一步的科学评估，但这需要 对患者队列进行合理分层，并在足够大的数量下进行研究，以产生统计学稳健性 调查结果。为了对患者进行分层，必须客观地测量初始损伤的严重程度，以免它仍然是一个危险因素。 将继续排除有意义调查的实质性混杂因素。我们已经开发并 在临床环境中测量骨折严重程度的有效技术。目标1：我们将扩大和 加快这种基于CT的方法，以更好地评估关节骨折，实施新技术， 评估关节碎裂、碎片分散和软组织损伤。目的2：在一个前瞻性的多- 中心研究，我们将与一个新的基于计算机的方法， 我们将不断地对订单案例的严重性进行排名，并将这两个严重性指标与 PTOA的发展。目的3：我们将在一项前瞻性研究中分析胫骨损伤踝关节的滑液。 Plafond骨折患者，以收集有关关节损伤和术后早期恢复的描述性数据， 伤期。这些生物标志物将与加速损伤严重性度量相关，并且每种生物标志物都与加速损伤严重性度量相关。 将与患者结局相关。 与公共卫生的相关性：骨折延伸至关节的患者，如 如踝关节或膝关节，一般预后不良，最终关节炎是常见的致残结果。 外科医生依靠主观经验来指导关节骨折的治疗，这在很大程度上 阻碍了进步。这项研究将提供全新的客观的非侵入性方法来测量 关节骨折损伤严重程度。这些方法本身将具有重要的临床意义， 并为统计学上可靠的临床/转化研究提供了一个新的框架，以降低 PTOA。