Surgical Simulations to Optimize the Treatment of Wrist Osteoarthritis

手腕骨关节炎是一种退行性疾病，会引起剧烈疼痛。这种疼痛限制了身体的功能，经常导致无法工作。减轻疼痛最可靠的方法之一是手术。然而，目前的手术治疗永久性地降低了手腕的活动范围和握力。这种握力的丧失尤其有害，因为它限制了患者进行日常生活活动的能力，包括拿起平底锅和开门。本研究的目的是确定两种治疗骨关节炎的方法（近端行腕骨切除术（PRC）和舟状骨切除四角融合术（SE4CF））后限制握力的生物力学因素。PRC和SE4CF特别令人感兴趣，因为尽管有大量回顾性研究比较了这两种方法，但对于哪一种方法在保持握力方面更好尚无共识。此外，PRC和SE4CF以不同的方式改变了手腕的生物力学设计，这表明不同的因素限制了每次手术后的握力。在拟议的研究中，将在术后力量损伤（目标3）的背景下测量和评估术后肌肉产生力矩（目标1）和力量产生参数（目标2）。在Aim 1中，将进行一项尸体实验，测量模拟PRC和SE4CF后腕部和拇指外源性肌肉的肌肉力矩臂。在目的2中，将使用超声在体内测量腕部主要肌肉的术后肌纤维长度。在Am 3中，将在体内测量术后手腕和手部力量，这些数据将用于肌肉骨骼计算机模型，以评估力臂和纤维长度的变化如何影响手腕、捏握和握力。这项工作的完成将提高对手腕设计如何影响手产生的力的科学理解，从而影响手的功能。最终，临床医生将能够利用从本研究中获得的知识来制定康复方案和手术技术，以克服术后损伤，从而改善患者的预后和生活质量。

Wrist osteoarthritis is a degenerative disease that causes severe pain. This pain limits functional abilities and frequently causes the inability to work. One of the most reliable methods to reduce pain is surgery. However, current surgical treatments permanently decrease wrist range of motion and grip strength. This loss of grip strength is particularly detrimental because it limits patient's abilities to perform activities ofdaily living, including picking up a saucepan and opening a door. The objective of this proposal is to identify the biomechanical factors that limit grip strength following two procedures to treat osteoarthritis: proximal row carpectomy (PRC) and scaphoid-excision four-corner fusion (SE4CF). PRC and SE4CF are of particular interest because there is no consensus regarding which is better at preserving grip strength, even though there are a large number of retrospective studies comparing these procedures. Additionally, PRC and SE4CF change the biomechanical design of the wrist in different ways, suggesting that different factors limit grip strength following each procedure. In the proposed study, post-operative muscle moment-generating (Aim 1) and force-generating parameters (Aim 2) will be measured and evaluated in the context of post-operative impairments in strength (Aim 3). In Aim 1, a cadaveric experiment will be conducted to measure the muscle moment arms of the primary wrist and extrinsic thumb muscles following simulated PRC and SE4CF. In Aim 2, post-operative muscle fiber length of the primary wrist muscles will be measured in vivo using ultrasound. In Am 3, post-operative wrist and hand strength will be measured in vivo, and these data will be used in musculoskeletal computer models to evaluate how changes in moment arm and fiber length influence wrist, pinch, and grip strength. Completion of this work will improve the scientific understanding of how the design of the wrist influences the forces produced by the hand, and thereby affects hand function. Ultimately, clinicians will be able to use knowledge gained from this study to develop rehabilitation protocols and surgical techniques to overcome post-operative impairments, thereby improving patient outcomes and quality of life. Through this research, the applicant will gain experience in performing experiments involving both cadavers and human subjects as well as using computer modeling to enhance the interpretation of experimental results. The applicant will receive additional training on teaching effectively, collaborating on interdisciplinary teams, and presenting to both scientific and clinical audiences. These experiences will teach the applicant technical and professional skills that are essential for a lifelong research career.