Based On The Finite Element Analysis To Explore The Clinical Effect Of Guanxinning Injection In The Hip Joint Cavity In The Treatment Of Femoral Head Necrosis

Objectives:1 Through the analysis of the correlation between the MRI imaging changes of Guanxinning injection in the hip joint cavity in the treatment of femoral head necrosis and the improvement of hip pain symptoms and functional activities,to evaluate the clinical efficacy of Guanxinning injecti-on in the hip joint cavity infusion in the treatment of femoral head necrosis.2 Explore the accuracy of using three-dimensional finite element analy-sis to determine the bone density and volume of the femoral head necrosis area.3 Based on the three-dimensional finite element analysis method,the biomechanical changes of the hip joint cavity perfusion of Guanxinning injection in the treatment of femoral head necrosis,and the changes in bone density and volume in the necrotic area are analyzed,and new ideas for the treatment of femoral head necrosis by Guanxinning injection in the hip joint cavity The theoretical basis.Methods:1 MRI evaluation of the clinical study of the femoral head necrosis treated by Guanxinning injection hip joint cavity perfusion treatment.From June 2020 to March 2021,in the Department of Orthopedics and Traumatology of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,20 patients with early and mid-term femoral head necrosis who received Guanxinning injection hip perfusion treatment were collected,with 8 single hips.Cases,a total of 32 cases have hips.All patients underwent MRI examination of the hip joint before the hip joint cavity perfusion treatment with Guanxinning injection.After 6 months of treatment with the hip joint cavity perfusion treatment with Guanxinning injection,the hip joint MRI examination was reexamined,and the treatment was observed and treated by MRI coronal STIR image.Before and after femoral head necrosis,the changes of bone marrow edema and hip joint cavity fluid were used.VAS scores were used to evaluate the changes of hip pain before and after treatment of femoral head necrosis,and the Harris scores were used to evaluate the changes of hip joint function before and after treatment of femoral head necrosis.Spearman correlation analysis was used to analyze the correlation between bone marrow edema and hip joint cavity grading changes before and after femoral head necrosis treatment,hip pain and hip joint function grading changes,and to judge the MRI imaging before and after the hip joint cavity perfusion treatment with Guanxinning injection Whether the change has a certain correlation with the improvement of clinical symptoms.2 Three-dimensional finite element analysis method to determine the bone density and volume analysis of femoral head necrosis.10 specimens of adult femoral head necrosis without obvious collapse in hip arthroplasty were collected.In the experimental group,10 femoral head specimens were scanned by CT thin-layer scan to establish the femoral head The three-dimensional model of the necrotic area,complete the pre-process-ing of the model-related finite element analysis,and output it to the Abaqus software to extract the bone density（ρ）,volume（V）and mass（M）of the femoral head necrosis area;the control group uses an electronic scale to weigh the femoral head mass（M₁）,measure the volume of the femoral head（V₁）with the "overflow method",remove the necrotic bone of the femoral head,and measure the mass（M₂）and volume（V₂）of the femoral head after the necrotic bone is removed in the same way,and the mass of the femoral head necrosis area M₀=M₁-M₂,volume of femoral head necrosis area V₀=V₁-V₂,bone density of femoral head necrosis area ρ₀=M₀/V₀.Perform statist-ical analysis of the results.3 The finite element study of the hip joint cavity perfusion with Guanxinning injection for the treatment of femoral head necrosis.The patients with unilateral femoral head necrosis collected in the first part of the clinical study were used as the finite element analysis research object,a total of 8 patients,and the health of patients with femoral head necrosis The femoral head on the side served as the control group（8 hips）,and the femoral head on the affected side served as the treatment group（8 hips）.The patients underwent hip CT examination before treatment,and after 6 months of treatment with Guanxinning injection in the hip joint cavity,the hip joint CT was rechecked,and the CT image data before and after treatment were collected as research data.3D finite element analysis model establish-ment method:①Import the CT image data of the patient’s hip joint in DICOM format.In Mimics21.0 software,the 3D model mask of the proximal femur is identified through automatic segmentation,and the 3D model mask of the femoral head necrosis area is selected by manual segmentation.After repairing the leakage of the board and the mask,a rough three-dimensional model is established by calculation;②Carry out surface lubrication and modification of 3D model in 3-Matic software,create 3D model surface mesh,volume mesh and assembly model,and set the load-bearing surface and constraint surface of the assembly model.③Import the three-dimensional model back to the Mimics 21.0 software.Based on the empirical formula of CT gray value and bone density of the proximal femur,the femoral head necrosis zone model is given 10 material properties,and the necrotic femoral head proximal femoral three-dimensional model and femoral head necrosis are obtained respectively.Zone 3D model,normal femoral head 3D model of proximal femur and normal femoral head 3D model,save the model file in inp format;④The 3D model is imported into Abaqus software,set the load surface to load 3000N in the opposite direction of Z axis Force,fix the restraining surface of the distal femur,perform finite element biomechanical analysis,and extract the bone density and volume of the femoral head necrosis area model,and the bone density of the normal femoral head model.Analyze the biomechanical conduction mechanism of the proximal femur before and after treatment of normal femoral head and femoral head necrosis,observe the biomechanical changes of the femoral head,the biomechanical changes of the necrotic area,the bone density and volume changes of the femoral head necrosis,and the changes of CT images of femoral head necrosis.Results:1 MRI evaluation of the clinical study of the femoral head necrosis of the hip joint cavity perfusion treatment of Guanxinning injection1.1 The changes of evaluation indexes before and after the hip joint cavity perfusion treatment of Guanxinning injectionThe changes of bone marrow edema before and after the hip joint cavity perfusion treatment of Guanxinning injection There was a statistical difference（P<0.05）,bone marrow edema was significantly reduced after treatment;there was no statistical difference in the changes of hip joint cavity effusion（P>0.05）,there was no significant change in hip joint cavity effusion after treatment;hip pain changes were statistically significant Difference（P<0.05）,the degree of pain was significantly reduced after treatment;the changes in hip joint function were statistically different（P<0.05）,and the hip joint function was significantly improved after treatment.1.2 Correlation analysis of evaluation indicatorsThe classification of hip pain before treatment is related to the classification of bone marrow edema（r=0.905）.The heavier the degree of bone marrow edema,the more severe the symptoms of hip pain;the classification of hip pain after treatment is related to the classification of bone marrow edema.Sex（r=0.681）,the more obvious the reduction of bone marrow edema,the more obvious the improvement of hip pain symptoms.The classification of hip joint function before treatment is correlated with the classification of bone marrow edema（r=0.850）.The more severe the degree of bone marrow edema,the worse the function of the hip joint.After treatment,the classification of hip joint function is correlated with the classification of bone marrow edema（r=0.752）.The more obvious the reduction of bone marrow edema,the more obvious the improvement of hip joint function.2 Three-dimensional finite element analysis method to determine the bone density and volume analysis of femoral head necrosisThere is no difference between the control group and the experimental group in the results of the bone density measurement of the femoral head necrosis area（P>0.05）;the control group and the experimental group have no difference in the results of the measurement of the femoral head necrosis area volume（P>0.05）,and the three-dimensional finite element analysis method can accurately determine Bone density and volume in the area of femoral head necrosis.3 Finite element study of Guanxinning injection hip joint cavity perfus-ion in the treatment of femoral head necrosis3.1 Biomechanical analysis of proximal femur before and after treatment of normal and femoral head necrosis3.1.1 Biomechanical analysis of normal femoral head of proximal femurThe internal stress of the bone is evenly distributed,and there is no obvious stress concentration.The compressive stress is evenly distributed in the femoral head along the pressure bone trabecula.There is no stress concentration at the junction of the femoral head and the femoral neck.Stress,the femoral talar is the most important bearing area of compressive stress,showing the largest stress,and the more the lateral femur goes to the greater tuberosity,the smaller the compressive stress.The displacement responds to the magnitude of the deformation,the proximal femoral head has a large deformation,and the deformation gradually decreases toward the distal end of the femur.The maximum displacement is located in the weight-bearing area of the femoral head.3.1.2 Biomechanical analysis of the proxi-mal femur before treatment of femoral head necrosis.Compared with the normal femoral head,the stress distribution in the necrotic area of the femoral head is extremely uneven,and there are multiple stress concentration areas.Compared with the necrosis area,the stress is concentrated in the necrotic area and The junction of the non-necrotic zone is more obvious,the femoral head and the femoral neck junction appear obvious compressive stress concentration phenomenon,the compressive stress on the inner side of the femoral neck and the femoral distance is significantly increased,and there is an obvious high stress concentration zone,and the maximum stress appears in the femoral neck The compressive stress on the inside and outside of the femoral neck increases slightly.After femoral head necrosis,the maximum displacement of the weight-bearing area increased significantly,indicating that the compressive stress in the weight-bearing area increased.3.1.3 Biomechanical analysis of the proximal femur after the treatment of femoral head necrosis is compared with that before treatment.After Guanxinning injection hip joint cavity perfusion treatment,there is still stress concentration in the necrotic area of the femoral head,but the stress distribution is higher than before treatment.Evenly,the stress concentr-ation distribution at the junction of the femoral head and the femoral neck is relatively reduced.The high stress concentration at the medial femoral neck and the femoral talar is significantly improved,the maximum stress is significantly reduced,and the stress distribution on the lateral femoral neck is also reduced.The maximum displacement of the weight-bearing area of the femoral head was significantly reduced after treatment,indicating that the deformation of the compressive stress in the weight-bearing area was reduced.3.1.4 Comparison of the results of the maximum stress and maximum displacement of the proximal femur before treatmentThe maximum stress and maximum displacement of the proximal femur before treatment were significantly different from those of the control group（P<0.05）.The maximum stress and maximum displacement of the proximal femur before treatment were significantly greater than those of the control group;the maximum stress and maximum displacement of the proximal femur before treatment were The difference between displacement and after treatment was statistically significant（P<0.05）.After treatment,the maxi-mum stress and maximum displacement of the proximal femur were significa-ntly smaller than before treatment;the maximum stress and maximum displacement of the proximal femur after treatment were significantly different from those of the control group Significance（P<0.05）,the maximum stress and maximum displacement of the proximal femur after treatment were still significantly greater than those in the control group.3.2 The biomechanical changes of the femoral head before and after treatment with Guanxinning injection in the hip joint cavity.The maximum stress of the femoral head after treatment was significan-tly different from that before treatment（P<0.05）,the stress concentration of the femoral head was relatively improved after treatment,and the maximum stress was significantly reduced;the maximum displacement of the femoral head after treatment was significantly different from that before treatment Statistically significant（P<0.05）,the maximum displacement of the femoral head was significantly reduced after treatment.3.3 The biomechanical changes in the necrotic area before and after the treatment of Guanxinning injection in the hip joint cavity.The difference between the maximum stress in the necrotic area after treatment and before treatment was statistically significant（P<0.05）,the stress concentration in the necrotic area was relatively improved after treatment,and the maximum stress was significantly reduced;the difference between the maximum displacement after treatment and before treatment was statistically significant For academic significance（P<0.05）,the maximum displacement of the necrotic area was significantly reduced after treatment.3.4 The femoral head before and after the hip joint cavity perfusion treatment with Guanxinning injectionThere was a statistically significant difference in bone mineral density between before treatment and the control group（P<0.05）.The bone density in the femoral head necrosis area before treatment was significantly lower than that in the control group;the difference in bone mineral density before and after treatment was statistically significant（P<0.05）After the treatment,the bone density of the femoral head necrosis area was significantly greater than that before the treatment;the bone density difference between the treatment and the control group was statistically significant（P<0.05）,and the bone density of the femoral head necrosis area was significantly greater than the control group after treatment.There was no significant difference in volume before and after treatment（P>0.05）,and there was no significant change in the volume of femoral head necrosis before and after treatment.3.5 CT changes of femoral head necrosis before and after the treatment of hip joint cavity perfusion with Guanxinning injectionBefore treatment of femoral head necrosis,the CT images of the femoral head showed sheet-like low-density images,some of the bone trabeculae were missing,and there were cystic light-transmitting areas;Guanxinning CT images after hip cavity perfusion treatment showed that the femoral head necrosis did not worsen,the bone density of new bone formation in the necrotic area was improved,the sclerosis zone was formed obviously,the area of the necrotic area was not significantly enlarged,the femoral head did not collapse significantly,and the hip joint space existed.Conclusions:1MRI evaluation of the clinical study of Guanxinning injection hip joint cavity perfusion treatment of femoral head necrosis1.1 Guanxinning injection hip joint cavity perfusion can significantly improve the bone marrow edema secondary to femoral head necrosis.1.2 Guanxinning injection hip joint cavity perfusion can significantly improve hip pain and hip joint function limitation caused by femoral head necrosis.1.3 Guanxinning injection hip joint cavity perfusion improves hip pain and joint function of femoral head necrosis and is closely related to the dissipation and absorption of bone marrow edema.The more obvious the reduction of bone marrow edema,the more obvious the improvement of hip pain and hip joint function.2 Three-dimensional finite element analysis method to determine the bone density and volume analysis of femoral head necrosis2.1 Three-dimensional finite element analysis method can accurately determine the bone density and volume of the femoral head necrosis area,and can be used as a way to determine the bone density and volume of the femoral head necrosis area method.3 Finite element study of the treatment of femoral head necrosis with Guanxinning injection in the hip joint cavity3.1 The stress distribution of the normal femoral head is uniform,and there is no stress concentration.The internal pressure stress of the femoral head is mainly transmitted to the medial femoral neck and the femoral distance,and the compressive stress transmitted to the lateral femoral neck is relatively small.3.2 The stress distribution in the necrotic area of the femoral head is uneven,the stress concentration is obvious at the junction of the necrotic area and the non-necrotic area,and the medial femoral neck and the femoral distance show high stress concentration.3.3 Guanxinning injection hip joint cavity perfusion can promote bone regeneration,increase bone density,improve bone strength,restore part of the effective support of the necrotic area,improve stress conduction barriers,reduce stress concentration,so as to reduce the risk of collapse and maintain the femoral head The therapeutic effect of complete form.