Intraoperative Optimization and Validation of Musculoskeletal Reconstruction

这个项目的长期目标是改善外科手术的结果。 涉及骨骼肌移位，无论是肌肉移位还是移植。在……下面 之前得到V.A.Rehab R&D的支持，我们描述了参与的肌肉的设计 肌腱移植手术，并开发了用于研究它们的高分辨率工具。在这 建议，我们开发了一种相对罕见的臂丛神经损伤的外科手术，在这种手术中， 股薄肌通过手术分离，然后移植到手臂上充当肘部。 屈肌。关键的想法是，这种外科手术第一次允许我们完全 术中确定单个人骨骼肌的特征，然后预测和 随后在体内测试其功能。此外，因为股薄肌是唯一一块作用于 我们可以显式地测试我们的模型来优化这个手术和相关类型的手术，因为没有 其他肌肉也参与屈肘运动。我们的三个目标是(1)，衡量 股薄肌肌节长度与术中主动和被动力学性能 在30例外科移植患者中，(2)比较预测的和实际的 股薄肌移位术后一、二年，(3)发展实用股薄肌 培训外科医生执行这些复杂程序的工具。 这项提议包括三个目标。前两个目标是相互关联的。目标1 介绍了一项复杂的术中实验，其中股薄肌被测量 活体，隔离，然后移植到手臂上。这个目标是基于我们以前的 肌腱移植手术和肌肉生物力学测试的术中经验。 这项实验的新奇之处在于，首次获得了完整的结构和功能数据 SET将从一块人体肌肉中获得。在目标2中，使用确定性模型 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)，我们将确定典型的生物力学建模方法是否 在给定最详细的组织水平的情况下，该领域可以准确地预测肘关节屈曲扭矩 从人类肌肉中直接收集的参数。如果是，这将是第一个明确的 对这种方法的验证。如果不是，我们将能够识别和分离该因素(S) 这些都是模拟有效性的障碍。 AIM 3直接来自于我们与梅奥诊所外科医生的讨论。我们有 花了大量的时间训练他们的肌肉主动和被动 在我们执行这些程序时的机械和功能特性。然而，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，但不是在实际手术室中。Aim 3正是通过 给测力计编程，让它像手术室里的肌肉一样“感觉”，然后练习 根据其已知的属性对其进行“转移”。 这个项目的成功完成将提高我们对人类骨骼的了解 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 臂丛神经手术和相关肌腱移位手术的手术指南。

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.