Mechanical Basis for Tensioning Tendon Transfers

描述（由申请人提供）： 脊髓损伤患者、头部受伤患者和中风患者通常受益于使用肌腱转移的手术重建。虽然存在许多转移程序，但执行肌腱转移仍然是一门艺术而不是科学。我们认为，关于肌腱移植手术的科学原理的许多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理解。已经创建了数学模型来设计最佳的肌腱转移，然而，几乎无一例外地，这些模型是基于使用“通用”肌肉模型，其属性是基于大量的缩放和生理假设。我们认为，目前的建模工作几乎注定要失败，因为人体肌肉的被动生物力学特性是未知的，几乎所有的人体上肢肌肉的正常工作范围从来没有被测量。在这项研究中，我们提出的实验，将确定基本的被动生物力学特性的肌细胞，肌纤维束（细胞加细胞外基质），和整个肌肉在三个最常见的转移人类肌肉肱桡肌，屈腕尺侧肌，旋前圆肌。这三种肌肉涵盖了转移肌肉中所见的复杂性范围。我们将使用这些数据来制定具体的指导方针，这些肌肉的肌腱转移到VA社区。此外，我们将进行技术开发的一个用户友好的设备，以测量肌肉肌节长度精确地通过反射激光衍射（RLD）。这种方法比我们以前的方法更快，不需要任何组织解剖。总之，这些实验将使退伍军人事务部外科医生在圣地亚哥退伍军人事务部和全国其他退伍军人事务部医疗中心的肌腱转移手术中设定标准。

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.