Muscle-driven, implanted endoprostheses for musculoskeletal limb reconstruction

用于肌肉骨骼肢体重建的肌肉驱动植入式内置假体

• 批准号: 10261509
• 负责人: Dustin L. Crouch
• 金额: $ 31.85万
• 依托单位: UNIVERSITY OF TENNESSEE KNOXVILLE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-11 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261509
• 关键词: Affect; Amputation; Anatomy; Animal Model; Ankle; Appearance; Articular Range of Motion; Artificial Implants; Behavior; Biological; Biomechanics; Clinical; Conceptions; Data; Defect; Devices; Electric Stimulation; Esthesia; Future; Geometry; Goals; Hindlimb; Histology; Immobilization; Impairment; Implant; Joints; Knee; Knowledge; Life; Limb Prosthesis; Limb structure; Locomotion; Measurement; Measures; Mechanics; Mission; Modeling; Motor; Movement; Muscle; Musculoskeletal; Musculoskeletal Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Operative Surgical Procedures; Orthopedics; Oryctolagus cuniculus; Outcome; Output; Patients; Phase; Prosthesis; Public Health; Quality of life; Recommendation; Recovery; Recovery of Function; Research; Research Support; Residual state; Sensorimotor functions; Sensory; Skin; Technology; Tendon structure; Testing; Time; Tissues; Triceps Brachii Muscle; Ultrasonography; bone; clinical translation; experimental study; foot; functional outcomes; high reward; high risk; implantation; improved; in vivo; innovation; mechanical properties; muscular structure; novel; prevent; prototype; reconstruction; research and development; residual limb; tibialis anterior muscle

PROJECT SUMMARY The long-term goal of the proposed translational project is to improve the sensorimotor function of people with amputation and other severe musculoskeletal defects. Physically attaching muscles to limb prostheses could restore natural motor and sensory function to patients. Since all prostheses must be worn externally on the body, the previous approach required transferring muscle forces through skin, which had limitations in function and appearance. To better facilitate physical muscle-prosthesis attachment, the proposed project introduces endoprostheses, which are jointed limb prostheses that can be completely implanted within living skin. The geometry and mechanical properties will likely differ between endoprosthetic and biological limbs, and endoprostheses may be implanted at different times across clinical cases. There is an urgent need to understand how the endoprosthesis and muscle reattachment timing affect muscle structure and motor function. The overall objective of the proposed project is to determine the effects and interactions of muscle reattachment timing (immediate vs delayed) and context (biological vs endoprosthetic limb) on muscle structure and motor function in a rabbit model of below-knee amputation. The project’s central hypothesis is that muscle structure and motor function will recover with delayed reattachment across an endoprosthetic ankle but will be best when reattached immediately across a biological ankle. The rationale for the proposed research is that it will provide critical in vivo data to support our future research and inform how endoprostheses are implemented clinically. Phase 1 of the project includes two aims: (Aim 1) quantify the effect of reattachment timing on muscle structure and motor function in a biological limb context, and (Aim 2) determine the effect of muscle reattachment context (biological vs endoprosthetic limb) on muscle structure and motor function. In Phase 2, Aim 3 is to evaluate the interaction effect of reattachment timing and context. The endoprosthesis will replace the rabbit hindlimb ankle and foot, and muscles in the residual limb will be attached across the endoprosthetic ankle using synthetic tendon. Muscle structure will be measured by ultrasound imaging, tissue measurements, and histology. Motor function will be assessed by measuring hindlimb biomechanics during locomotion and ankle force-generating capacity during electrical stimulation of muscles attached to the endoprosthesis. The expected outcomes of the proposed research are a working in vivo experimental platform – an MDE prototype and animal model – data on muscle structure and motor function for different reattachment timings and contexts. The endoprostheses concept is highly innovative and radically different from existing externally worn limb prostheses. Endoprostheses are significant because they will enhance sensorimotor function and make limb prostheses more attractive, comfortable, and convenient to use, drastically improving patients’ independence and quality of life.

项目总结 拟议的翻译项目的长期目标是改善患有疾病的人的感觉运动功能。 截肢和其他严重的肌肉骨骼缺陷。将肌肉物理连接到假肢上可以 恢复患者的自然运动和感觉功能。因为所有的假体都必须戴在 对于身体，以前的方法需要通过皮肤传递肌肉力量，这在功能上有局限性 和外表。为了更好地促进肌肉假体的连接，拟议的项目引入了 内假体，即可完全植入活体皮肤内的关节肢体假体。这个 假肢和生物肢体的几何和机械性能可能会有所不同，而且 不同的临床病例可能会在不同的时间植入假体。有迫切的需要 了解假体植入和肌肉重接时机如何影响肌肉结构和运动 功能。拟议项目的总体目标是确定肌肉的影响和相互作用。 肌肉的再附着时间(即刻与延迟)和环境(生物假肢与假肢内) 兔膝下截肢模型的结构和运动功能。该项目的中心假设是 肌肉结构和运动功能将通过内假体延迟再附着而恢复 脚踝，但如果立即跨生物脚踝重新连接将是最好的。建议的理由是 研究表明，它将提供关键的活体数据，以支持我们未来的研究并告知 假体植入是在临床上实施的。项目第一阶段包括两个目标：(目标1)量化 在生物肢体环境中，重接时机对肌肉结构和运动功能的影响，以及(目标2) 确定肌肉再附着环境(生物假肢与假肢内)对肌肉结构的影响 和运动功能。在第二阶段，目标3是评估重新依附时间和背景的交互影响。 假体将取代兔后肢的踝关节和足部，残肢的肌肉将被 用人造肌腱固定在假体内的脚踝上。肌肉结构将通过以下方式测量 超声波成像、组织测量和组织学。运动功能将通过测量进行评估 后肢运动时的生物力学和电刺激时的踝关节发力能力 附着在假体上的肌肉。拟议研究的预期结果是一项工作 活体实验平台-MDE原型和动物模型-肌肉结构和运动数据 函数用于不同的重新连接时间和上下文。人工假体的概念是高度创新的， 从根本上不同于现有的外部佩戴的假肢。内固定术意义重大，因为它们 将增强感觉运动功能，使假肢更美观，更舒适，更方便 使用，极大地提高了患者的独立性和生活质量。