| ObjectiveTo explore the role of biomechanics in the course of non-traumatic osteonecrosis of the femoral head based on the biomechanical changes following normal and non-traumatic osteonecrosis of the femoral head,and to provide a biomechanical reference for the clinical treatment of non-traumatic osteonecrosis of the femoral head.To explore the biomechanical mechanism of Jianpi Huogu recipe combined with core decompression and bone grafting in the treatment of non-traumatic osteonecrosis of the femoral head based on the biomechanical changes before and after Jianpi Huogu recipe combined with core decompression and bone grafting in the treatment of non-traumatic osteonecrosis of the femoral head,and provide a biomechanical reference for Jianpi Huogu recipe combined with core decompression and bone grafting in the treatment of non-traumatic osteonecrosis of the femoral head.MethodClinical and imaging data of 30 patients diagnosed with osteonecrosis of the femoral head and hospitalized in our hospital from September 2 020 to September 2022 were collected.In 30 patients,the cause of osteonecrosis of the femoral head was non-traumatic and the onset side was unilateral osteonecrosis of the femoral head,with ARCO stages Ⅰ or Ⅱ.Traditional Chinese Medicine syndrome differentiation was phlegm and stasis obstruction.Thirty patients were suitable and willingly chosen to undergo the treatment protocol of Jianpi Huogu recipe combined with core decompression and bone grafting.Twenty hips were randomly selected from the healthy side of the femoral head of 30 patients as the normal group and 30 hips from the affected side as the experimental group.The Jianpi Huogu recipe was administered for 3 months as a course of treatment for 2 sessions.During the treatment period,the patient will move around with the help of double crutches and return to our hospital for follow-up examinations including imaging data at 3 months and 6 months after the start of treatment.The patient’s CT data in DICOM format was imported into Mimics version 19.0 software and the proximal femur area was selected to generate a 3D model of the proximal femur,which was saved as a stl format file.The proximal femur model in stl format was smoothed and accurately surfaced in Geomagic Studio 2012 to produce the proximal femur model in stp format.The proximal femur model in stp format was meshed in ANSA version 19.1.6 and the meshed proximal femur model was saved as a cdb file.In the Mimics 19.0 software,the cdb format proximal femur model was assigned based on gray value and saved with the Ansys Preprocessor files option.Open ANSYS version 19 software,import the cdb format 3D model of the proximal femur,set the stress area,force value and direction,set the fixation area,import the material properties after the gray value assignment,simulates a force value of 2.5 times the patient’s own body weight,derive the maximum equivalent stress and maximum deformation,generate the stress map and deformation map.ResultCompared to the maximum equivalent stress of 38.24 MPa in the normal group,the maximum equivalent force of 47.19 MPa in the experimental group increased by 8.95 MPa,and the difference was statistically significant(P<0.05).The maximum equivalent stress of the femoral head was 47.19MPa,35.08MPa and 31.26MPa before and 3 and 6 months after Jianpi Huogu recipe combined with core decompression and bone grafting treatment respectively,compared to before treatment,the maximum equivalent stress decreased by 12.11MPa and 15.93Mpa after 3 and 6 months after treatment respectively,and the difference was statistically significant(P<0.05).The maximum equivalent stress was reduced by 3.82 MPa after 6 months of treatment compared to 3 months after treatment,and the difference was statistically significant(P<0.05).The maximum deformation of the femoral head in the experimental group was 3.26μm compared to 2.63μm in the normal group,an increase of 0.63μm,and the difference was statistically significant(P<0.05).The maximum deformation of the femoral head before treatment and after 3 and 6 months of Jianpi Huogu recipe combined with core decompression and bone grafting treatment was 3.23μm,2.46μm and 2.33μm respectively,compared with that before treatment,the maximum deformation of the femoral head after 3 and 6 months of treatment was reduced by 0.77μm and 0.90μm respectively,and the difference was statistically significant(P<0.05)..The maximum deformation was reduced by 0.13μm after 6 months of treatment compared to 3 months after treatment,and the difference was statistically significant(P<0.05).ConclusionThe femoral head of non-traumatic osteonecrosis of femoral head has a significantly reduced weight-bearing capacity and is more prone to deformation and desctruction.Although conservative treatment and unbraced hip preservation surgery can alleviate symptoms and improve functions,it may have limited effect in preventing and delaying the collapse of the femoral head and is suitable for patients with early stage and small area of necrosis.For patients with large area of necrosis,their weight-bearing capacity should be fully evaluated.When selecting the treatment plan,treatment options with supportive effects should be considered to avoid and delay the collapse of the femoral head.Jianpi Huogu recipe combined with core decompression and bone grafting can enhance the weight-bearing capacity of the femoral head of non-traumatic osteonecrosis of femoral head,its mechanism probably be that Jianpi Huogu recipe regulates lipid metabolism,improves microcirculation by repairing vascular damage and promoting angiogenesis and promote bone formation,while core decompression and bone grafting probably played the role of a tunnel and bridge pier through drilling and bone grafting,providing a more convenient access to the necrotic area for Jianpi Huogu recipe ’s active ingredients,blood vessels and osteogenic tissues,and the implanted allogeneic bone filling part of the cystic area,thus partially relieving the stress concentration and stress transmission barriers,the layers of compression have a bracing effect,and thus increase the weight-bearing capacity of the necrotic femoral head. |
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