Interaction of pre-operative structural failure sites and operative repair strategies in prolapse: A biomechanical modeling approach

描述（由申请人提供）：骨盆器官脱垂严重到足以导致每年超过200,000名妇女进行手术修复，并且预计随着人口老龄化，患病率将增加。然而，手术干预失败率显著，前腔室脱垂是最常见的失败部位。缺乏识别导致脱垂的结构缺陷的具体位置和大小的能力，以及预测特定女性特定手术策略的成功，限制了我们理解手术失败的能力，并影响有效的手术计划和治疗创新。鉴于这方面的知识差距，我们建议开发一种计算机建模方法，使外科医生能够评估不同盆底手术策略对不同类型和骨盆支持缺陷组合的个体的结果。我们寻求资金来建立概念框架，并通过关注根尖悬吊手术（如腹骶colpop固定术）来证明其可行性。目标1：基于多重结构失效假设，创建特定受试者的生物力学预测模型，并根据术后MRI测量结果验证这些模型预测。Aim 2，进行敏感性分析，系统研究术前各种结构损伤及结构损伤组合对根尖悬吊手术效果的影响，识别单纯根尖悬吊手术不足以恢复前房室支持的损伤组合及阈值。这些模型可以扩展到预测其他手术入路的结果，如阴道旁修复和中线前阴道破裂术，以及它们在后续R01中与根尖悬吊手术的相互作用。这些完整和经过验证的模型可以作为实验平台，让外科医生和生物医学设计工程师以快速、安全、普遍廉价的方式回答有关手术计划和治疗创新的问题，并最大限度地减少对接受盆腔脱垂手术的女性的潜在伤害。

DESCRIPTION (provided by applicant): Pelvic organ prolapse severe enough to result in surgical repair in over 200,000 women each year and is anticipated to increase in prevalence with our aging population. However, the rate of surgical intervention failure is significant and anterior compartment prolapse is the most common site of failure. Lack of the ability to identify the specific combination of site and magnitude of structure defects leading to her prolapse and predict the success of a given operative strategy in a given specific woman limit our ability to understand operative failure and hinge the effective surgical planning and treatment innovation. Given this knowledge gap, we propose to develop a computer modeling approach that will allow surgeons to evaluate the outcome of various pelvic floor surgical strategies in individuals with different types and combinations of pelvic support defects. We seek funding to establish the conceptual framework and demonstrate the feasibility by focusing on apical suspension surgeries such as abdominal sacrocolpopexy surgery for anterior compartment predominant prolapse. Aim 1, Create subject-specific biomechanical prediction models based on the multiple structural failure hypothesis and validate those model predictions against post-operative MRI measurements. Aim 2, Conduct sensitivity analyses, systematically study how various pre-operative structural impairments and combinations of structural impairments affect apical suspension surgery outcome, and identify impairment combinations and thresholds beyond which apical suspension surgery alone is not adequate to restore anterior compartment support. These models can be extended to predict the outcome of other surgical approaches such as the paravaginal repair and midline anterior colporrhaphy as well as their interaction with apical suspension surgery in the subsequent R01. These complete and validated models could be used as experimental platform allowing surgeons and biomedical design engineers answer the questions regarding to surgical planning and treatment innovations in a fast, safe and generally inexpensive manner and minimize potential harm for women who undergo pelvic prolapse surgery.