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Surgical Simulations Based on Limited Quantitative Data: Understanding How Musculoskeletal Models Can Be Used to Predict Moment Arms and Guide Experimental Design

机译：基于有限的定量数据的手术模拟：了解如何使用骨骼肌肉模型预测力矩臂并指导实验设计

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The utility of biomechanical models and simulations to examine clinical problems is currently limited by the need for extensive amounts of experimental data describing how a given procedure or disease affects the musculoskeletal system. Methods capable of predicting how individual biomechanical parameters are altered by surgery are necessary for the efficient development of surgical simulations. In this study, we evaluate to what extent models based on limited amounts of quantitative data can be used to predict how surgery influences muscle moment arms, a critical parameter that defines how muscle force is transformed into joint torque. We specifically examine proximal row carpectomy and scaphoid-excision four-corner fusion, two common surgeries to treat wrist osteoarthritis. Using models of these surgeries, which are based on limited data and many assumptions, we perform simulations to formulate a hypothesis regarding how these wrist surgeries influence muscle moment arms. Importantly, the hypothesis is based on analysis of only the primary wrist muscles. We then test the simulation-based hypothesis using a cadaveric experiment that measures moment arms of both the primary wrist and extrinsic thumb muscles. The measured moment arms of the primary wrist muscles are used to verify the hypothesis, while those of the extrinsic thumb muscles are used as cross-validation to test whether the hypothesis is generalizable. The moment arms estimated by the models and measured in the cadaveric experiment both indicate that a critical difference between the surgeries is how they alter radial-ulnar deviation versus flexion-extension moment arms at the wrist. Thus, our results demonstrate that models based on limited quantitative data can provide novel insights. This work also highlights that synergistically utilizing simulation and experimental methods can aid the design of experiments and make it possible to test the predictive limits of current computer simulation techniques.
机译：目前，由于需要大量的实验数据来描述给定的程序或疾病如何影响骨骼肌肉系统，因此限制了生物力学模型和模拟方法用于检查临床问题的实用性。能够预测外科手术如何改变个体生物力学参数的方法对于有效开发外科手术模拟是必需的。在这项研究中，我们评估基于有限数量数据的模型在多大程度上可以用来预测手术如何影响肌肉力矩臂，这是定义肌肉力如何转化为关节扭矩的关键参数。我们专门检查了近端行鲤鱼切除术和舟状切除四角融合术，这是治疗腕骨关节炎的两种常见手术。使用基于有限数据和许多假设的这些手术模型，我们执行模拟以制定有关这些手腕手术如何影响肌肉力矩臂的假设。重要的是，该假设仅基于主要腕部肌肉的分析。然后，我们使用尸体实验来测试基于模拟的假设，该实验测量主腕和外在拇指肌肉的力矩臂。测量的主要腕部肌肉的弯矩臂用于验证假设，而外部拇指肌肉的弯矩臂用作交叉验证，以检验该假设是否可以推广。由模型估算并在尸体实验中测量的力矩臂均表明，手术之间的关键区别在于它们如何改变腕尺radial臂与radial伸力矩臂的关系。因此，我们的结果表明，基于有限的定量数据的模型可以提供新颖的见解。这项工作还强调，协同使用模拟和实验方法可以帮助设计实验，并有可能测试当前计算机模拟技术的预测极限。

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