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[1]李泰賢,李曉亮,趙繼陽,等.健脾活骨方治療非創(chuàng)傷性股骨頭壞死的生物力學(xué)機制研究[J].中醫(yī)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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健脾活骨方治療非創(chuàng)傷性股骨頭壞死的生物力學(xué)機制研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年09期
頁碼:
29-35
欄目:
技術(shù)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:
李泰賢1; 李曉亮1; 趙繼陽1; 李2; 何海軍2; 陳黎明1; 趙萬寧1; 許根榮1; 董士宇1; 白晶1; 郭盛君1; 陳衛(wèi)衡3
(1.北京中醫(yī)藥大學(xué)第三附屬醫(yī)院,北京 100029; 2.中國中醫(yī)科學(xué)院望京醫(yī)院,北京 100102; 3.中醫(yī)骨傷治療與運動康復(fù)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
關(guān)鍵詞:
股骨頭壞死;  健脾活骨方;  限定因素分析;  生物力學(xué)現(xiàn)象
Keywords:
femur head necrosis;  Jianpi Huogu Fang;  finite element analysis;  biomechanical phenomena
摘要:
目的:探討健脾活骨方治療非創(chuàng)傷性股骨頭壞死的生物力學(xué)機制。方法:選擇20例單側(cè)非創(chuàng)傷性股骨頭壞死患者作為研究對象。男7例,女13例; 左髖8例,右髖12例; 年齡21～58歲,中位數(shù)48歲; 國際骨微循環(huán)研究學(xué)會分期均為Ⅱ期。所有患者均采用口服健脾活骨方和藥物動脈灌注治療,健脾活骨方每日1劑,共服用180 d; 藥物動脈灌注共治療1次。分別于治療開始前、治療開始后3個月及治療開始后1年進行CT掃描,建立股骨近端和壞死骨三維有限元模型,測定股骨頭負重區(qū)與壞死骨的最大總形變量和最大等效應(yīng)力。結(jié)果:①股骨頭負重區(qū)最大總形變量和最大等效應(yīng)力。治療開始前、治療開始后3個月和治療開始后1年,股骨頭負重區(qū)最大總形變量比較,差異有統(tǒng)計學(xué)意義[(4.101±1.341)mm,(3.296±1.203)mm,(3.356±1.022)mm,F=5.646,P=0.008]。治療開始后3個月和治療開始后1年股骨頭負重區(qū)最大總形變量均較治療開始前減小(P=0.036,P=0.007); 治療開始后3個月和治療開始后1年股骨頭負重區(qū)最大總形變量的差異無統(tǒng)計學(xué)意義(P=0.576)。治療開始前、治療開始后3個月和治療開始后1年,股骨頭負重區(qū)最大等效應(yīng)力比較,差異無統(tǒng)計學(xué)意義[(1.837±0.804)MPa,(1.717±0.649)MPa,(1.586±0.593)MPa,F=1.145,P=0.332]。②壞死骨最大總形變量和最大等效應(yīng)力。治療開始前、治療開始后3個月和治療開始后1年,壞死骨最大總形變量和最大等效應(yīng)力總體比較,差異有統(tǒng)計學(xué)意義[最大總形變量:(3.963±1.302)mm,(3.157±1.126)mm,(3.202±1.012)mm,F=5.930,P=0.007; 最大等效應(yīng)力:(1.246±0.445)MPa,(1.470±0.601)MPa,(1.323±0.433)MPa,F=4.224,P=0.024]。治療開始后3個月和治療開始后1年壞死骨最大總形變量均較治療開始前減小(P=0.032,P=0.008); 治療開始后3個月和治療開始后1年壞死骨最大總形變量的差異無統(tǒng)計學(xué)意義(P=0.517)。治療開始后3個月壞死骨最大等效應(yīng)力較治療開始前增大(P=0.030),治療開始后1年與治療開始前壞死骨最大等效應(yīng)力的差異無統(tǒng)計學(xué)意義(P=0.076); 治療開始后3個月和治療開始后1年壞死骨最大等效應(yīng)力的差異無統(tǒng)計學(xué)意義(P=0.202)。結(jié)論:健脾活骨方治療非創(chuàng)傷性股骨頭壞死的生物力學(xué)機制,可能是通過增強壞死骨的強度與剛度,使壞死骨可以提供有效支撐,減輕股骨頭負重區(qū)的應(yīng)力集中現(xiàn)象、解除壞死骨區(qū)域正常骨組織高應(yīng)力狀態(tài),從而起到治療作用。
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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備注/Memo

備注/Memo:
基金項目:國家自然科學(xué)基金項目(82030122,81373801,81973888); 北京市自然科學(xué)基金項目(7182186); 北京中醫(yī)藥大學(xué)新教師啟動基金項目(2022-JYB-XJSJJ-085); 北京中醫(yī)藥大學(xué)科研平臺建設(shè)項目(2023-JYB-KYPT-03); 北京中醫(yī)藥大學(xué)中醫(yī)骨傷治療與運動康復(fù)智能化教育部工程研究中心培育項目(BZYSY-2022-GCYJZXQX-07)
通訊作者:陳衛(wèi)衡 E-mail:drchenweiheng@163.com
更新日期/Last Update: 1900-01-01