Mechanical Basis for Tensioning Tendon Transfers

描述(由申请人提供)： 脊髓损伤患者、脑损伤患者和中风患者通常受益于使用肌腱转移的手术重建。尽管存在许多转移程序，但进行肌腱转移仍然更像是一门艺术，而不是一门科学。我们认为，关于肌腱移植手术的科学基础的大部分不确定性是基于对肌腱移植中使用的肌肉的生物力学特性的误解或完全缺乏了解。然而，已经建立了数学模型来设计最优的肌腱转移，然而，这些模型几乎无一例外地基于使用基于大量比例和生理假设的“通用”肌肉模型。我们认为，目前的建模工作几乎注定要失败，因为人类肌肉的被动生物力学特性是未知的，而且几乎所有人类上肢肌肉的正常工作范围从未被测量过。在这项资助中，我们介绍了一些实验，这些实验将定义肌肉细胞、肌肉纤维束(细胞和细胞外基质)和三种最常见的人类肌肉--腕尺侧屈肌和旋前圆肌--的基本被动生物力学特性。这三块肌肉涵盖了转移肌肉的复杂程度。我们将使用这些数据来制定将这些肌肉的肌腱转移到VA社区的具体指南。此外，我们将开发一种用户友好的设备，通过反射激光衍射(RLD)精确测量肌肉肌节长度。这种方法比我们以前的方法更快，而且不需要任何组织解剖。总而言之，这些实验将使退伍军人管理局的外科医生能够在圣地亚哥退伍军人管理局和全国其他退伍军人医学中心设立肌腱转移手术的标准。 公共卫生相关性： 退伍军人管理局的大量任务涉及中风、头部损伤和脊髓损伤后的手术干预。该提案的一部分将为医生在重建过程中做出手术决定提供指导。外科手术效率的提高将极大地帮助康复过程。我们还将提供有用的数据，治疗师保守地治疗患者进行力量训练，因为肌肉的生理状况将被定义。在这两种情况下，这些研究都将影响很大一部分正常的VA住院和门诊患者，基于改善的结果，应该会显著节省时间和精力，以及改善患者的独立性和功能。

DESCRIPTION (provided by applicant): Spinal cord injury patients, head injured patients, and stroke victims often benefit from surgical reconstruction using tendon transfers. While numerous transfer procedures exist, performing tendon transfers remains more of an art than a science. We believe that much of the uncertainty regarding the scientific rationale for tendon transfer procedures is based on either a misunderstanding or a complete lack of understanding of the biomechanical properties of muscles used in tendon transfers. Mathematical models have been created to design optimal tendon transfers, however, almost without exception these models are based on the use of "generic" muscle models whose properties are based on a multitude of scaling and physiological assumptions. We opine that current modeling efforts are almost predestined to failure because the passive biomechanical properties of human muscles are unknown and the normal operating range of almost all human upper extremity muscles has never been measured. In this grant, we present experiments that will define the basic passive biomechanical properties of muscle cells, muscle fiber bundles (cells plus extracellular matrix), and whole muscles in three of the most commonly transferred human muscles-brachioradialis, flexor carpi ulnaris, and pronator teres. These three muscles cover the range of complexity seen in transferred muscles. We will use these data to develop specific guidelines for tendon transfer of these muscles to the VA community. In addition, we will perform technology development of a user-friendly device to measure muscle sarcomere length precisely by reflected laser diffraction (RLD). This method has the advantage over our previous method of being faster and not requiring any tissue dissection. Taken together, these experiments will allow VA surgeons to set the standard in tendon transfer surgery both at the San Diego VA and other VA Medical Centers throughout the country. PUBLIC HEALTH RELEVANCE: A great deal of the VA mission involves surgical intervention after stroke, head injury and spinal cord injury. A portion of this proposal would provide guidelines to physicians making surgical decisions during reconstructive procedures. Improved efficacy of surgical procedure will greatly aid the rehabilitative process. We will also provide data useful to therapists treating patients conservatively with strength training since the physiological condition of the muscles will be defined. In both cases, these studies will affect a large fraction of the normal VA inpatient and outpatient population and, based on improved outcomes, should result in significant savings of time and energy as well as improved patient independence and function.