Intraoperative Optimization and Validation of Musculoskeletal Reconstruction

该项目的长期目标是改善外科手术的结果 包括骨骼肌转移，无论是肌肉移位还是移植。下 此前，V.A.康复研发，我们的特点是设计的肌肉参与， 肌腱转移手术，并开发了高分辨率的工具来研究它们。在这 建议，我们开发了一种相对罕见的臂丛神经损伤的手术方法，其中， 通过手术分离股薄肌，然后将其移植到手臂上作为肘部 屈肌关键的想法是，这种外科手术允许我们，第一次， 在手术中表征单个人骨骼肌，然后预测和 随后在体内测试其功能。此外，由于股薄肌是唯一的肌肉作用于 我们可以明确地测试我们的模型，以优化这种手术和相关类型的手术，因为没有 其它肌肉参与手肘弯曲运动。我们的三个目标是（1），衡量 术中股薄肌肌节长度与主、被动力学特性 在30例外科移植患者中，（2）比较预测和实际功能， 移植股薄肌术后1年和2年，（3）制定一个实用的 培训外科医生进行这些复杂手术的工具。 这项建议包括三个目标。前两个目标是相互关联的。要求1 提出了一个复杂的术中实验中，股薄肌肌测量， 体内，在隔离，然后移植到手臂后。这一目标是基于我们以前的 肌腱移植术中经验和肌肉生物力学测试。 这项实验的新奇在于，第一次，一个完整的结构和功能数据 将从单个人体肌肉中获得。在aim 2中，使用 肌肉功能（而不是当前的模型，这些模型是不确定的，必须通过 优化），我们将确定是否使用典型的生物力学建模方法， 该领域可以准确地预测肘关节屈曲扭矩给定的最详细的一套组织水平 直接从人体肌肉中采集的参数。如果是，这将是第一个明确的 验证这种方法。如果不是，我们将能够识别和隔离因素 这是模拟有效性的障碍。 目标3直接来自我们与马约诊所外科医生的讨论。我们有 我花了大量的时间训练他们的肌肉主动和被动 机械性能和功能特性。但他们 鼓励我们创建一个培训工具，让全国各地的其他外科医生 使用相同的概念进行培训，但不是在实际的手术室中。Aim 3就是这样做的， 编程一个测力计，让它像手术室里的肌肉一样“感觉”， 根据其已知的性质“转移”它。 这个项目的成功完成将提高我们对人类骨骼的理解 肌肉生物力学，测试我们模拟人体关节功能的能力，并提供具体的 臂丛神经手术和相关肌腱转移手术的手术指南。

The long-term goal of this project is to improve the outcome of surgical procedures involving skeletal muscle transfer, whether muscle transposition or transplantation. Under previous support from V.A. Rehab R&D, we characterized the design of muscles involved in tendon transfer surgery and developed high-resolution tools with which to study them. In this proposal, we exploit a relatively rare surgical procedure for brachial plexus injury, in which the gracilis muscle is surgically isolated and then transplanted into the arm to act as an elbow flexor. The key idea is that this surgical procedure allows us, for the first time, to completely characterize a single human skeletal muscle intraoperatively and then to predict and subsequently test its function in vivo. Further, because gracilis is the only muscle acting at the elbow we can explicitly test our model to optimize this and related types of surgery since no other muscles are involved in the elbow flexion movement. Our three aims are (1), to measure gracilis muscle sarcomere length and active and passive mechanical properties intraoperatively during surgical transplantation in 30 patients, (2) to compare predicted and actual function of the transferred gracilis muscle one- and two-years postoperatively, and (3) to develop a practical tool to train surgeons to perform these complex procedures. This proposal consists of three aims. The first two aims are interconnected. Aim 1 presents a sophisticated intraoperative experiment in which gracilis muscles are measured in vivo, in isolation, and then after transplantation into the arm. This aim is based on our previous intraoperative experience with tendon transfer surgery and biomechanical testing of muscle. The novelty of this experiment is that, for the first time, a complete structural and functional data set will be obtained from a single human muscle. In aim 2, using a deterministic model of muscle function (rather than current models which are indeterminate and must be solved by optimization), we will determine whether the typical biomechanical modeling approaches used in the field can accurately predict elbow flexion torque given the most detailed set of tissue-level parameters ever directly collected from a human muscle. If it is, this will be the first explicit validation of such an approach. If it is not, we will be able to identify and isolate the factor(s) that are obstacles to simulation validity. Aim 3 came directly out of our discussions with surgeons at the Mayo Clinic. We have spent a tremendous amount of time training them regarding muscle active and passive mechanical and functional properties as we perform these procedures. However, they encouraged us to create a training tool that would allow other surgeons across the country to be trained using the same concepts but not in the actual operating room. Aim 3 does just that by programming an ergometer to “feel” just like a muscle in the operating room and then to practice “transferring” it based on its known properties. Successful completion of this project will improve our understanding of human skeletal muscle biomechanics, test our ability to model human joint function, and provide concrete surgical guidelines for this brachial plexus surgery and related tendon transfer surgeries.