Fregly Benjamin J
Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL.
Int J Comput Vis Biomech. 2009 Jul 1;2(2):145-155.
Disorders of the human neuromusculoskeletal system such as osteoarthritis, stroke, cerebral palsy, and paraplegia significantly affect mobility and result in a decreased quality of life. Surgical and rehabilitation treatment planning for these disorders is based primarily on static anatomic measurements and dynamic functional measurements filtered through clinical experience. While this subjective treatment planning approach works well in many cases, it does not predict accurate functional outcome in many others. This paper presents a vision for how patient-specific multibody dynamic models can serve as the foundation for an objective treatment planning approach that identifies optimal treatments and treatment parameters on an individual patient basis. First, a computational paradigm is presented for constructing patient-specific multibody dynamic models. This paradigm involves a combination of patient-specific skeletal models, muscle-tendon models, neural control models, and articular contact models, with the complexity of the complete model being dictated by the requirements of the clinical problem being addressed. Next, three clinical applications are presented to illustrate how such models could be used in the treatment design process. One application involves the design of patient-specific gait modification strategies for knee osteoarthritis rehabilitation, a second involves the selection of optimal patient-specific surgical parameters for a particular knee osteoarthritis surgery, and the third involves the design of patient-specific muscle stimulation patterns for stroke rehabilitation. The paper concludes by discussing important challenges that need to be overcome to turn this vision into reality.
人类神经肌肉骨骼系统的疾病，如骨关节炎、中风、脑瘫和截瘫，会显著影响行动能力并导致生活质量下降。针对这些疾病的手术和康复治疗计划主要基于静态解剖测量以及通过临床经验筛选的动态功能测量。虽然这种主观的治疗计划方法在许多情况下效果良好，但在其他许多情况下并不能准确预测功能结果。本文提出了一种设想，即如何将针对患者的多体动力学模型作为一种客观治疗计划方法的基础，该方法能在个体患者的基础上确定最佳治疗方法和治疗参数。首先，提出了一种用于构建针对患者的多体动力学模型的计算范式。这种范式涉及针对患者的骨骼模型、肌肉 - 肌腱模型、神经控制模型和关节接触模型的组合，完整模型的复杂性由所解决临床问题的要求决定。接下来，介绍了三个临床应用，以说明此类模型如何用于治疗设计过程。一个应用涉及为膝关节骨关节炎康复设计针对患者的步态修改策略，第二个应用涉及为特定的膝关节骨关节炎手术选择最佳的针对患者的手术参数，第三个应用涉及为中风康复设计针对患者的肌肉刺激模式。本文最后讨论了要将这一设想变为现实需要克服的重要挑战。
