OMEGA - Optimization-based forward musculoskeletal simulation of pathological gait

在人类医学的许多领域，尤其是矫形外科和创伤外科，对人体及其各部分的运动和负荷的知识是必不可少的。现代数值方法已经发展到可以根据先验知识、运动和外部载荷来估计相关结构中的力的程度。然而，它们的普遍用途受到限制，因为它们无法预测运动和负荷，以响应疾病引起的身体变化或应用特定疗法治疗疾病的结果。该项目的目标是开发新一代正向模拟器，基于最优运动的计算，以承诺预测并因此改进针对个别患者的治疗策略。这种模拟器将帮助医学摆脱单纯依赖于基于证据的治疗方法的纯粹经验方法，达到指导和预测治疗的可能。为此，将开发和实施一种创新的前向肌肉骨骼模拟器(FMS)。虽然该模拟器未来可以应用于广泛的肌肉骨骼疾病，但它将首先在三种特别选定的临床情况下进行测试和进一步发展：膝关节和脚踝支撑、下垂足病理学和使用微处理器控制的膝关节假体治疗的膝上截肢。之所以选择这三种临床情况，是因为它们具有很好的特点，治疗方式可以非侵入性地改变，而不会给患者带来不应有的风险，而且有足够数量的患者可用。虽然相对简单，但每一种病理都代表着受影响患者的生活质量严重下降，治疗方法的普遍改进，特别是根据个别患者的需要调整治疗方式，将对生活质量产生严重影响。在这三个案例中，将在临床步态分析实验室的背景下开发一个框架，通过使用直接运动学和动力学测量以及反向动态模拟的组合作为从各自的患者收集的地面真实数据来验证和进一步开发。FMS预测能力未来最明显的应用领域之一是髋关节和膝关节的晚期骨关节炎的治疗，即全髋关节(THA)和全膝关节置换术(TKA)。这些手术的费用是一个重大的、日益严重的经济挑战。这进一步表明了该项目将进行的基础研究的重要性，并显示了重大的医学和经济影响：改善治疗，并为预测与肌肉骨骼疾病有关的许多情况下的治疗结果提供强有力的新方法。

Knowledge of the motion and loading of the human body and its parts is essential in many fields of human medicine and in particular in orthopedic and trauma surgery. Modern numerical methods have advanced to the point that they are useful for estimating forces in the relevant structures based on a priori knowledge motion and external loading. However, their general usefulness is limited by their inability to predict motion and loading in response to changes in the body caused by disease or as a result of applying a given therapy to treat a disease. The aim of this project is to develop a new generation of forward simulator, based on the computation of most optimal motions, with the promise of predicting and thus improving therapeutic strategies for individual patients. Such simulator will help moving medicine away from a purely empirical approach which relies on the evolution of therapies based on evidence alone, to a point where guiding and predicting therapies is possible. An innovative forward musculoskeletal simulator (FMS) will be developed and implemented for this purpose. Although the simulator could in the future be applied to a wide range of musculoskeletal disorders it will first be tested and further evolved in three specially selected clinical situations: Knee and Ankle Bracing, Drop Foot Pathology, and Above Knee Amputation treated with a microprocessor-controlled knee-prosthesis. These three clinical situations were chosen because they are well characterized, treatments modalities can be altered non-invasively without undue risk to the patients, and sufficient numbers of patients are available. Although relatively simple, each of these pathologies represents a serious reduction in quality of life for the affected patients and general improvements in treatment approaches and in particular the adaptation of treatment modalities to the needs of individual patients will have a serious impact on quality of life. In all three cases a framework will be developed in the context of a clinical gait analysis laboratory, validated and further developed by using a combination of direct kinematic and kinetic measurements and inverse dynamic simulations as ground-truth data obtained from respective patient collectives.One of the most obvious areas of future application of the predictive capabilities of FMS is the treatment of advanced OA of the hip and knee, i.e. total hip (THA) and total knee arthroplasty (TKA). The cost of these procedures represents a significant and increasing economic challenge. This is a further indication of the significance of the basic-research to be performed in this project and demonstrates a major medical and economic impact: improving the treatment of, and providing powerful new methods for predicting the outcome of treatments in many contexts related to musculoskeletal diseases.