The Study Of The Relation Of Blood Stasis Syndrome And Osteonecrosis Of Femoral Head,the Geometric Parameter Of Necrotic Area And Related Finite Element Analysis

Objectives1.Blood Stasis(BS)is most commonly seen in Osteonecrosis of Femoral Head(ONFH).Relief of Blood Stasis(BS)by blood reactivation method is one of the most commonly used treatment for this BS clinical condition.There were limited investigations of ONFH along the Axis of "Pain(P)-Blood Stasis(BS)-Quality of Life(QOL)".The objective of this study is to establish this "P-BS-QOL Axis" for future clinical investigations.Through the collection of signs from BS of the Traditional Chinese Medicine(TCM)and using the BS scaling and other assessment tools,the reliability of these assessment tools and scale is examined,and the applications results of these assessment tools in the eval uation of ONFH clinical conditions is evaluated.2.This study utilizes Computer Aided Software to study the Computer Tomography(CT)images of the subjects recruited in paragraph 1 for the parameters of their specific geometric shape of:total surface area;volume;surface projections,necrosis-head-volume ratio.Thus,the second leg the Axis"Functional Disability-Hip Joint Force Instability can be established.3.The 3D models of the ONFH of the above patients are re-established by Fini te Element Analysis,and the stress values of several common day-to-day activities(standing and going up stairs)is studied,studying the,factors affecting the femoral head structural stabilities;and ultimately building up the Axis of "Blood Stasis(BS)-Pain(P)-Functional Disabilities(FD)-Biological Force Instability(FI)"Methodology1.After meeting the inclusion criteria and in the Outpatient or Inpatient settings,the recruited pat:i ents are requested to fi 11 in VAS,HHS,iHOT,SF-12,SDS and SAS assessment tools.The TCM 4-signs of these patients are collected and the BS status are scored,according the China Government TCM Bureau s BS standard.2.The BS scores is compared with the iHOT scores for clinical judgement.The CT of this patients is stored in DICOM format.The software of MIMICS 19.Ois used to read this DICOM data,and through the functions of "threshold""Region Grow" etc.,the model of the necrotic area,acetabulum,cortical and medulla bones are established as stl documents.These stl documents are input into Geomagic Studio 2013 software.The Finite Element Analysis(FEA)are use with their "relax" "nail shape removal" functions for smoothing out the computer models generated.Then other functions such as "precision arch surface" "Outline Investigation" "Curve Surface Restructuring" are also used,finally exporting the igs document.This igs document is then injected into Solidworks 2017,saved as prt document.The "surface area"and "volume" of the ONFH necrotic area is then measured and evaluated.3.The Finite Element Analysis is used to build the ONFH model and simulated rotation centre of the acetabulum cartilage,cortical bone,medulla bone is evaluated for 2 common daily activities:standing and going upstairs.The data is then injected into the Hypermesh software for the model grid,turning out to inp documents.The imnp document is then imported to the Abaqus System.The cortical bone bouncing quantity is+10.5MPa,bouncing ratio is 0.3.The medulla bone is 445MPa,and bouncing ration is 0.22.The cartilage is+10.5MPa,bouncing ratio 0.45.After setting up the situation,the working position of standing and going upstairs is studied by applying the stress tests.Von Mises Stress is evaluated for bone strength.Results1.This study investigated 24 cases of ONFH ARCO 2 ONFH patients,with 24 successful cases.Out of these 24 cases,15 cases are bilateral hip involvement,9 cases are one-sided.There are 9 female cases(37.5%),and 15 cases male(62.5%).The oldest male patient is aged 53 while the youngest is 19,with an average age of 34.4+-11.9.The oldest female patient aged 47 and the youngest 25,with an average of 37.9+-7.4.There is no statistical significance between male and female cases.The BS score is correlated with VAS score.The Pearson shows there is significant negative correlations(r=0.45,P=0.03).The BS score with HHS shows correlations:r=0.55,P=0.006.BS with iHOT show negative correlations:r=-0.63,P=0.001).There is no significant for the BS with SF-12 PCS 13,P=0,54),there is significant correlation between BS and SF-12 MCS(r=-0.44,P=0.03).The BS score show no correlations both with the anxiety score(r=0.06,P=0.78)and the depression score(r=0.13,P=0.55)2.There is significance between iHOT score and the necrotic volume(r=-0.48,P=0.02)but no significance between iHOT and the necrotic surface area(r=-0.11,P=0.62).There is no significance between iHOT and the coronary projection(r=-0.06,P=0.78).There is no significance between iHOT and the sagittal projection(r=-0.17,P=0.43).There is strong correlations between iHOT and the horizontal projection surface(r=-0.63,P=0.001).There is correlations between iHOT and the necrotic/volume ratio(r=-0.47,P=0.0226).3.There is correlation between iHOT with the standing position(r=-0.51,P=0.01).There is correlation between coronary projection with standing maximum stress(r=-0.59,P=0.003).There is correlation between coronary projection with going stairs(r=-0.71,P=0.01).Conclusion1.The overall severity of Blood Stasis(BS)is heavily related with early stage of the ONFH,not only presenting as hip pain and functional disabilities,but also affecting the anxiety and negative emotions.ONFH patients unavoidably will be in a state of chronic disease conditions.As such,besides prescribing psychotic drugs,other psychological treatment and educations is helpful to the patients with ONFH.Through this study,the Axis of Blood Stasis(BS)-Pain(P)-Functional Disabilities(FD)-Biological Force Instability(FI)" is existing.2.The symptoms of ONFH correlate greater with the horizontal projection than with the necrotic/head ratio;and the necrotic surface area is more significant than the volume of the necrotic volume.As a ball-and-socket joint,the necrotic area largely projects on the weigh-bearing surfaces,and the femoral head rotate on the acetabulum changing in different directions in walking and going up and downstairs.Except in standing,the crisscross force inside the hip joint will stress the cartilage inside the hip,causing hip joint instabilities in the long run.These may cause joint unstableness,micro-fracture inside the joint surface,and finally resulting in joint collapse.Horizontal necrotic area reflects the total surface area under stress and relates the cartilage under the joint surface.3.Horizontal surface necrotic areas is the weight bearing area od the hip joint.When this surface area gets larger,the stress gets heavier When going upstairs,there is a maximum stress force that will not increase with the activity.This may happen because the centre of gravity limits the increase with the going upstairs activity.4.With the results presented in this study,the Axis of "Blood Stasis(BS)-Pain(P)-Functional Disabilities(FD)-Biological Force Instability(FI)" really exists.Clinically,patients with obvious hip pain should be evaluated further for possibilities of unstable femoral head,leading ultimately to femoral head collapse.