[1]李泰贤,李晓亮,赵继阳,等.健脾活骨方治疗非创伤性股骨头坏死的生物力学机制研究[J].中医正骨,2024,36(09):29-35.
　LI Taixian,LI Xiaoliang,ZHAO Jiyang,et al.Biomechanical mechanism of Jianpi Huogu Fang(健脾活骨方)in treatment of non-traumatic osteonecrosis of the femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(09):29-35.
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健脾活骨方治疗非创伤性股骨头坏死的生物力学机制研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年09期
页码:
29-35
栏目:
技术研究
出版日期:
2024-09-20

文章信息/Info

Title:
Biomechanical mechanism of Jianpi Huogu Fang(健脾活骨方)in treatment of non-traumatic osteonecrosis of the femoral head
作者:
李泰贤1; 李晓亮1; 赵继阳1; 李2; 何海军2; 陈黎明1; 赵万宁1; 许根荣1; 董士宇1; 白晶1; 郭盛君1; 陈卫衡3
(1.北京中医药大学第三附属医院,北京 100029; 2.中国中医科学院望京医院,北京 100102; 3.中医骨伤治疗与运动康复智能化教育部工程研究中心,北京 100029)
Author(s):
LI Taixian1; LI Xiaoliang1; ZHAO Jiyang1; LI Yan2; HE Haijun2; CHEN Liming1; ZHAO Wanning1; XU Genrong1; DONG Shiyu1; BAI Jing1; GUO Shengjun1; CHEN Weiheng3
1.Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China 2.Wangjing Hospital of CACMS,Beijing 100102,China 3.Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent,Ministry of Education,Beijing 100029,China
关键词:
股骨头坏死;  健脾活骨方;  限定因素分析;  生物力学现象
Keywords:
femur head necrosis;  Jianpi Huogu Fang;  finite element analysis;  biomechanical phenomena
摘要:
目的:探讨健脾活骨方治疗非创伤性股骨头坏死的生物力学机制。方法:选择20例单侧非创伤性股骨头坏死患者作为研究对象。男7例,女13例; 左髋8例,右髋12例; 年龄21～58岁,中位数48岁; 国际骨微循环研究学会分期均为Ⅱ期。所有患者均采用口服健脾活骨方和药物动脉灌注治疗,健脾活骨方每日1剂,共服用180 d; 药物动脉灌注共治疗1次。分别于治疗开始前、治疗开始后3个月及治疗开始后1年进行CT扫描,建立股骨近端和坏死骨三维有限元模型,测定股骨头负重区与坏死骨的最大总形变量和最大等效应力。结果:①股骨头负重区最大总形变量和最大等效应力。治疗开始前、治疗开始后3个月和治疗开始后1年,股骨头负重区最大总形变量比较,差异有统计学意义[(4.101±1.341)mm,(3.296±1.203)mm,(3.356±1.022)mm,F=5.646,P=0.008]。治疗开始后3个月和治疗开始后1年股骨头负重区最大总形变量均较治疗开始前减小(P=0.036,P=0.007); 治疗开始后3个月和治疗开始后1年股骨头负重区最大总形变量的差异无统计学意义(P=0.576)。治疗开始前、治疗开始后3个月和治疗开始后1年,股骨头负重区最大等效应力比较,差异无统计学意义[(1.837±0.804)MPa,(1.717±0.649)MPa,(1.586±0.593)MPa,F=1.145,P=0.332]。②坏死骨最大总形变量和最大等效应力。治疗开始前、治疗开始后3个月和治疗开始后1年,坏死骨最大总形变量和最大等效应力总体比较,差异有统计学意义[最大总形变量:(3.963±1.302)mm,(3.157±1.126)mm,(3.202±1.012)mm,F=5.930,P=0.007; 最大等效应力:(1.246±0.445)MPa,(1.470±0.601)MPa,(1.323±0.433)MPa,F=4.224,P=0.024]。治疗开始后3个月和治疗开始后1年坏死骨最大总形变量均较治疗开始前减小(P=0.032,P=0.008); 治疗开始后3个月和治疗开始后1年坏死骨最大总形变量的差异无统计学意义(P=0.517)。治疗开始后3个月坏死骨最大等效应力较治疗开始前增大(P=0.030),治疗开始后1年与治疗开始前坏死骨最大等效应力的差异无统计学意义(P=0.076); 治疗开始后3个月和治疗开始后1年坏死骨最大等效应力的差异无统计学意义(P=0.202)。结论:健脾活骨方治疗非创伤性股骨头坏死的生物力学机制,可能是通过增强坏死骨的强度与刚度,使坏死骨可以提供有效支撑,减轻股骨头负重区的应力集中现象、解除坏死骨区域正常骨组织高应力状态,从而起到治疗作用。
Abstract:
Objective:To explore the biomechanical mechanism of Jianpi Huogu Fang(健脾活骨方,JPHGF)in treatment of non-traumatic osteonecrosis of the femoral head(NONFH).Methods:Twenty patients with unilateral NONFH were selected as the subjects.The patients consisted of 7 males and 13 females ranged in age from 21 to 58 years(Median=48 years).The ONFH located in left side for 8 patients,right for 12 ones,and belonged to stageⅡaccording to the staging standard issued by the Association Research Circulation Osseous(ARCO).All patients were treated with oral application of JPHGF,one dose a day for consecutive 180 days,and with arterial perfusion of normal saline and salvia miltiorrhiza injection in turn for one time.Furthermore,CT scans were conducted before the beginning of the treatment,at 3 and 12 months after the beginning of the treatment,respectively.Based on the CT scanning data,a three-dimensional(3D)finite element model of the proximal femur and necrotic bone was established,respectively,to measure the maximum total deformation(MTD)and maximum equivalent stress(MES)in the load-bearing area of femoral head and necrotic bone.Results:①The MTD and MES in the load-bearing area of femoral head.The difference was statistically significant in MTD in the load-bearing area of femoral head among the 3 timepoints(4.101±1.341,3.296±1.203,3.356±1.022 mm,F=5.646,P=0.008).The MTD in the load-bearing area of femoral head decreased at 3 and 12 months after the beginning of the treatment compared to pretreatment(P=0.036,P=0.007),while,the comparison between the 3 and 12 months after the beginning of the treatment revealed no significant difference(P=0.576).However,the difference was not statistically significant in MES in the load-bearing area of femoral head among the 3 timepoints(1.837±0.804,1.717±0.649,1.586±0.593 MPa,F=1.145,P=0.332).②The MTD and MES in the necrotic bone.The difference was statistically significant in MTD and MES in the necrotic bone among the 3 timepoints in general(MTD:3.963±1.302,3.157±1.126,3.202±1.012 mm,F=5.930,P=0.007; MES:1.246±0.445,1.470±0.601,1.323±0.433 MPa,F=4.224,P=0.024).The MTD in the necrotic bone decreased at 3 and 12 months after the beginning of the treatment compared to pretreatment(P=0.032,P=0.008),while,the comparison between 3 and 12 months after the beginning of the treatment revealed no significant difference(P=0.517).The MES in the necrotic bone increased at 3 months after the beginning of the treatment compared to pretreatment(P=0.030),while,the comparisons between the 12 months after the beginning of the treatment and before the beginning of the treatment,as well as between the 3 and 12 months after the beginning of the treatment revealed no significant difference(P=0.076,P=0.202).Conclusion:The JPHGF may work by making the necrotic bone to provide effective support through enhancing its strength and stiffness,which can reduce the stress concentration in the load-bearing area of femoral head,and relieve the high-stress state of the normal bone tissue in the area of necrotic bone,thereby achieving the therapeutic effects for NONFH.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82030122,81373801,81973888); 北京市自然科学基金项目(7182186); 北京中医药大学新教师启动基金项目(2022-JYB-XJSJJ-085); 北京中医药大学科研平台建设项目(2023-JYB-KYPT-03); 北京中医药大学中医骨伤治疗与运动康复智能化教育部工程研究中心培育项目(BZYSY-2022-GCYJZXQX-07)
通讯作者:陈卫衡 E-mail:drchenweiheng@163.com
更新日期/Last Update: 1900-01-01