Three-Dimensional Finite Element Analysis of Electroacupuncture for Patients with Knee Osteoarthritis During Ascent and Descent Stair
Xu Haifei1, Zhao Gaiping1*, Yang Jiajing1, Wang Xiangbin2*, Xu Shixiong3
1(School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093,China) 2(Rehabilitation Medical College of Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China) 3(Department of Mechanics and Engineering Science,Fudan University,Shanghai 200433, China)
Abstract：To explore the availability of finite element analysis method to simulate the biomechanical properties of knee osteoarthritis in the treatment of ascent and descent stair movements, the correlation between the changes of knee biomechanical behavior and the efficacy of electro-acupuncture treatment was compared. Based on image data obtained from CT and MRI, in combination with medical image processing software including Mimics and Geomagic, we established the three-dimensional finite element model of knee flexion 15° downstairs and 50° upstairs. The model included bone and soft tissue structures such as femur and tibia, humerus, medial and lateral meniscus, femoral cartilage, medial and lateral iliac cartilage. The stress distribution of the medial and lateral meniscus, femoral cartilage and medial and lateral tibial cartilage under electroacupuncture treatment were compared by applying the corresponding load on the center of the femoral condyle of the knee joint model of ascent and descent stairs. The research of knee osteoarthritis under electroacupuncture showed that the stress of the medial and lateral meniscus, femoral cartilage, and medial and lateral tibial cartilage was restored to varying degrees after electroacupuncture treatment. The maximum stress at the descent stairs was reduced by 0.543, 0.236, 0.194, 0.239 and 0.327 MPa, respectively. The maximum stress at the ascent stairs was reduced by 0.253, 0.31, 0.227, 0.112 and 0.122 MPa. The stress peak of each cartilage further tends to the normal knee joint, and the stress distribution range was closer to the normal state. The medial cartilage and meniscus of the joint were more loaded than the lateral side, which was consistent with the phenomenon that the clinical medial type of knee osteoarthritis is more than the lateral type. Therefore, it was demonstrated that electroacupuncture treatment could affect the transmission of the force in the knee joint, delay the degradation of cartilage in various parts of the knee joint, and make the stress ratio of each cartilage closer to the normal value. Therefore, the stability of the diseased knee joint was improved. In conclusion, the electroacupuncture treatment could effectively alleviate the stress concentration of articular cartilage in patients with knee osteoarthritis. The biomechanical properties of knee osteoarthritis under electroacupuncture could provide a theoretical basis for the treatment options of clinical knee joints.
许海飞, 赵改平, 杨加静, 王芗斌, 许世雄. 电针治疗膝骨性关节炎患者上下楼梯的三维有限元分析[J]. 中国生物医学工程学报, 2021, 40(3): 321-329.
Xu Haifei, Zhao Gaiping, Yang Jiajing, Wang Xiangbin, Xu Shixiong. Three-Dimensional Finite Element Analysis of Electroacupuncture for Patients with Knee Osteoarthritis During Ascent and Descent Stair. Chinese Journal of Biomedical Engineering, 2021, 40(3): 321-329.
[1] Pandit H, Hamilton TW, Jenkins C, et al. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: A 15-year follow-up of 1000 UKAs [J]. Bone Joint Surg Br, 2006, 88(1): 54-60. [2] Novak AC, Brouwer B. Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults [J]. Gait Posture, 2011, 33(1):54-60. [3] Fransen M, McConnell S, Harme AR,et al. Exercise for osteoarthritis of the knee: A cochrane systematic review [J]. Br J Sports Med, 2015, 49(24):1554-1557. [4] Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study [J]. Am J Public Health,1994,84(3):351-358. [5] Chikuda H, Yasunaga H, Horiguchi H, et al. Impact of age and comorbidity burden on mortality and major complications in older adults undergoing orthopaedic surgery: An analysis using the Japanese diagnosis procedure combination database [J]. BMC Musculoskelet Disord, 2013, 28(14):173. [6] Gulati A, Chau R, Simpson DJ,et al. Influence of component on outcome for unicompartmental for knee replacement [J]. Knee, 2009, 16(3): 196-199. [7] 程杰平,马洪顺,褚怀德. 骨性关节炎对膝关节软骨力学性质影响的实验研究 [J]. 医用生物力学, 2005, 20(1): 25-27. [8] 黄剑,卓廉士,彭支莲,等. 电针对家兔膝骨关节炎模型关节液中IL-β、IL-6和TNF-α的影响 [J]. 中国中医骨伤科杂志, 2007, 15(3): 17-18. [9] 裘敏蕾,戴琪萍,车涛,等. 电针膝眼穴治疗膝骨性关节炎的临床研究 [J]. 中医正骨, 2006, 18(3): 15-16. [10] 田雯,沈林林,黄国付,等. 电针改善不同病程膝骨关节炎患者WOMAC和VAS评分的临床研究 [J]. 针灸临床杂志, 2015(4): 26-28. [11] 王芗斌,侯美金,陈剑,等. 电针对膝骨性关节炎患者功能活动及登梯时空参数的影响 [J]. 中国中医基础医学杂志, 2017(8): 109-114. [12] 范琰,娄灵芝,程少丹,等. 膝关节骨性关节炎电针治疗研究进展. 按摩与康复医学 [J], 2010(3): 36-38. [13] Vaquero J, Arriaza R. The experimental study of patella thinning osteotomy,a new technique for reducing patellofemoral pressure [J]. Int Orthop, 1992, 16(4): 372-376. [14] 马青川,肖丽英,李志昌,等. 单侧全膝关节置换术后两下肢受力不对称的影响因素 [J]. 医用生物力学, 2015, 30(1): 89-93. [15] 张峻霞,窦树斐,苏海龙,等. 上、下楼梯步态参数变化特征研究 [J]. 医用生物力学, 2016, 31(3): 266-271. [16] 唐刚,魏高峰,周海,等. 测量并分析上楼梯过程中下肢关节角变化 [J]. 医用生物力学, 2011, 26(5): 460-464. [17] Lubovsky O, Mor A, Segal G, et al. Effect of a novel biomechanical treatment on pain, function and gait pattern in obese patients with knee osteoarthritis [J]. Osteoarthr & Cartilage, 2014, 22:S382-S383. [18] Zhu Guangduo, Guo Wangshou, Zhang Qidong, et al. Finite element analysis of mobile-bearing unicompartmental knee arthroplasty: The influence of tibial component coronal alignment [J]. Chin Med J (Engl), 2015,128(21): 2873-2878. [19] Wen Pengfei, Guo Wanshou, Gao Fuqiang, et al. Effects of lower limb alignment and tibial component inclination on the biomechanics of lateral compartment in unicompartmental knee arthroplasty [J]. Chin Med J (Engl), 2017, 130(21): 2563-2568. [20] Kang KT, Son J, Suh DS,et al. Patient-specific medial unicompartmental knee arthroplasty has a greater protective effect on articular cartilage in the lateral compartment: A finite element analysis [J]. Bone & Joint Research, 2018, 7(1): 20-27. [21] Moglo KE, Shirazi-Adl A. On the coupling between anterior and posterior cruciate ligaments,and knee joint response under anterior femoral drawer in flexion: a finite element study [J]. Clin Biomech, 2003, 18(8): 751-759. [22] 钟锦然. 基于三维有限元探讨电针对步行中膝骨性关节炎半月板应力的影响 [D]. 福州: 福建中医药大学, 2016. [23] Nadeau S, MeFadyen BI, Malouin F. Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years:What are the challenges compared to level walking? [J]. Clin Biomech, 2003, 18: 950-959. [24] Stacoff A,Diezi C,Luder G,et al. Ground reaction forces on stairs: Effects of stair inclination and age [J]. Gait Posture, 2005, 21(1): 24-38. [25] Costigan PA,Deluzio KJ,Wyss U P. Knee and hip kinetics during normal stair climbing [J]. Gait & Posture, 2002, 16(1): 31-37. [26] Riener R,Rabuffetti M,Frigo C. Stair ascent and descent at different inclinations [J]. Gait & Posture, 2002, 15(1): 32-44. [27] 张文. 基于ANSYS研究人体膝关节生物力学模型 [D]. 苏州: 苏州大学, 2010. [28] 商跃进. 有限元原理与ANSYS应用指南 [M]. 北京:清华大学出版社, 2005: 16-25. [29] Bendjaballah MZ,Shirazi-adl A,Zukor DJ. Biomachanics of the human knee joint in compression: Reconstruction,mesh generation and finite element analysis [J]. The Knee, 1995, 2(2): 69-79. [30] Donahue TLH, Hull ML, Rashid MM, et al. A finite element model of the human knee joint for the study of tibio-femoral contact [J]. J Biomech Eng, 2002, 124(3): 273-280. [31] Pena E, Calvo B, Martinez MA,et al. Why lateral meniscectomy is more dangerous than medial meniscectomy: A finite element study [J]. J Orthop Res, 2006, 24(5): 1001-1010. [32] Zhu Guangduo, Guo Wangshou, Cheng Limeng, et al. Finite element analysis of tibial slope in mobile-bearing unicompartmental knee arthroplasty [J]. Chin Med J (Engl), 2015, 128(21): 2873-2878. [33] Shriram D, Kumar GP, Cui Fangsen, et al. Evaluating the effects of material properties of artificial meniscal implant in the human knee joint using finite element analysis [J]. Sci Rep, 2017, 7(1): 6011. [34] Wang Xiangbin, Zhong Jinran, He Jian, et al. A dynamic finite element model of knee joint based on gait analysis [J]. Rehab Med, 2016, 26(3):5-11. [35] 江斌. 基于股胫关节有限元仿真分析的膝骨关节炎生物力学改变的研究 [D].上海: 上海交通大学, 2013. [36] Reeves ND, Bowling FL. Conservative biomechanical strategies for knee osteoarthritis [J]. Nat Rev Rheu, 2011, 7(2): 113-122. [37] Diffo Kaze A, Maas S, Arnoux PJ, et al. A finite element model of the lower limb during stance phase of gait cycle including the muscle forces [J]. BioMed Eng Online, 2017, 16(1): 138-156. [38] Lu Tungwu, Wei Ipin, Liu Yenhung, et al. Immediate effects of acupuncture on gait patterns in patients with knee osteoarthritis [J].Chin Med J (Engl), 2010, 123(2): 165-172. [39] 安丙辰,郑洁皎,沈利岩. 膝骨关节炎与膝关节伸、屈肌群肌力的相关性研究 [J]. 医用生物力学, 2015, 30(2): 174-178.
