Objective:To explore the biomechanical mechanism of Jianpi Huogu Fang(健脾活骨方,JPHGF)in treatment of non-trau-matic osteonecrosis of the femoral head(NONFH).Methods:Twenty patients with unilateral NONFH were selected as the subjects.The pa-tients 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 pa-tients,right for 12 ones,and belonged to stage Ⅱ according 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 treat-ment,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 time-points(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 de-creased 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 treat-ment revealed no significant difference(P=0.076,P=0.202).Conclusion:The JPHGF may work by making the necrotic bone to provide ef-fective 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.
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
Key words
femur head necrosis/Jianpi Huogu Fang/finite element analysis/biomechanical phenomena
维普
万方数据