Journal Pre-proof

The preventive effect of CT image-guided electroacupuncture combined with

continuous femoral nerve block on deep vein thrombosis after total knee arthroplasty
based on an adaptive algorithm

Xiangrong Guo, Fen Gui, Meiqin Guo, Junhong Peng, Xianjun Yu

PII: S1878-8750(20)32361-5
DOI: https://doi.org/10.1016/j.wneu.2020.10.159
Reference: WNEU 16257

To appear in: World Neurosurgery

Received Date: 31 August 2020

Revised Date: 29 October 2020
Accepted Date: 30 October 2020

Please cite this article as: Guo X, Gui F, Guo M, Peng J, Yu X, The preventive effect of CT image-
guided electroacupuncture combined with continuous femoral nerve block on deep vein thrombosis
after total knee arthroplasty based on an adaptive algorithm, World Neurosurgery (2020), doi: https://
doi.org/10.1016/j.wneu.2020.10.159.

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 The preventive effect of CT image-guided electroacupuncture combined with continuous
femoral nerve block on deep vein thrombosis after total knee arthroplasty based on an
adaptive algorithm

Xiangrong Guo1, Fen Gui2, Meiqin Guo3, Junhong Peng1, Xianjun Yu1*
1
Department of Radiology, The Fourth Hospital of Wuhan, Wuhan City 430033, China;
2
Department of Urology, The First Hospital of Wuhan, Wuhan City 430033, China;
3
Department of Cardiology, The First Hospital of Guiyang, Guiyang City 550000, China.

*Corresponding author: Xianjun Yu

Email: yuxianjunfhuh@126.com

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Abstract: Based on the adaptive algorithm model, this paper proposes two special model

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structures of randomized fusion and an optimized convolution kernel and uses it for image
recognition. It combined with the adaptive algorithm model image-guided electroacupuncture
-p
combined with a continuous femoral nerve block to prevent deep vein thrombosis after total knee
replacement. 200 patients after total knee replacement were randomly divided into 4 groups. We
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observe the incidence of postoperative lower limb deep vein thrombosis, platelet count before
and after surgery. Electroacupuncture combined with continuous femoral nerve block can reduce
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the incidence and has obvious advantages in multi-mode prevention. The effective analgesia
provided by electroacupuncture combined with continuous femoral nerve block can not only
relieve postoperative pain. It enabled patients to train joint activities and lower limb muscle
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strength as soon as possible, which is conducive to postoperative functional recovery, but also
reduces the body stress response triggered by pain and the hypercoagulable state. At the same
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time, electroacupuncture stimulation of acupuncture points can reduce the inflammatory edema
associated with surgery, improve blood circulation at the surgical site and activate the body's
Jo

anticoagulation mechanism. It provides new ideas and references for formulating multi-mode
prevention and control strategies.

Keywords: adaptive algorithm; CT image-guided electroacupuncture; nerve block; knee

replacement; deep vein thrombosis prevention
 The preventive effect of CT image-guided electroacupuncture combined with
continuous femoral nerve block on deep vein thrombosis after total knee arthroplasty
based on an adaptive algorithm

Xiangrong Guo1, Fen Gui2, Meiqin Guo3, Junhong Peng1, Xianjun Yu1*
1
Department of Radiology, The Fourth Hospital of Wuhan, Wuhan City 430033, China;
2
Department of Urology, The First Hospital of Wuhan, Wuhan City 430033, China;
3
Department of Cardiology, The First Hospital of Guiyang, Guiyang City 550000, China.

*Corresponding author: Xianjun Yu

Email: yuxianjunfhuh@126.com

Abstract: Based on the adaptive algorithm model, this paper proposes two special model

of
structures of randomized fusion and an optimized convolution kernel and uses it for image
recognition. It combined with the adaptive algorithm model image-guided electroacupuncture

ro
combined with a continuous femoral nerve block to prevent deep vein thrombosis after total
knee replacement. 200 patients after total knee replacement were randomly divided into 4
-p
groups. We observe the incidence of postoperative lower limb deep vein thrombosis, platelet
count before and after surgery. Electroacupuncture combined with continuous femoral nerve
re
block can reduce the incidence and has obvious advantages in multi-mode prevention. The
effective analgesia provided by electroacupuncture combined with continuous femoral nerve
lP

block can not only relieve postoperative pain. It enabled patients to train joint activities and
lower limb muscle strength as soon as possible, which is conducive to postoperative
na

functional recovery, but also reduces the body stress response triggered by pain and the
hypercoagulable state. At the same time, electroacupuncture stimulation of acupuncture
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points can reduce the inflammatory edema associated with surgery, improve blood circulation
at the surgical site and activate the body's anticoagulation mechanism. It provides new ideas
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and references for formulating multi-mode prevention and control strategies.

Keywords: adaptive algorithm; CT image-guided electroacupuncture; nerve block; knee

replacement; deep vein thrombosis prevention

1. Introduction
Deep Vein Thrombosis (DVT) is commonly used in major orthopedic surgery and is one
of the postoperative complications. It refers to the abnormal clotting of blood in the deep
veins. It is a venous reflux disorder and the most common site is the deep veins of the lower
extremities [1]. The incidence rate is increasing year by year. For patients without
conventional anticoagulation after TKA, 40.0% to 62.0% of patients will develop
postoperative DVT, and 0.7% to 5.0% of patients within 30 days will have post-thrombotic
syndrome. The formation of severe deep vein thrombosis can cause a pulmonary embolism
(PE), the incidence of symptomatic PE is 1.8% to 7%, and the fatal PE is 0.2% to 2% [2]. It is
fatal and can cause a post-thrombotic syndrome in the long run, which seriously affects the
quality of life of patients. Its prevention and treatment have become a focus and hot topic in
medical research [3, 4]. Early rehabilitation exercises have played a crucial role in the
recovery of joint function after orthopedic surgery. The degraded physiological function and
the slow adjustment response itself limit the movement of the affected limb, and the severe
postoperative pain further Restricting the functional exercise of the affected limb joints,
slowing the blood flow rate and coupled with blood loss and blood hypercoagulability caused
by surgical stimulation [5]. The above factors greatly increase the risk of DVT and PE. The
perfect analgesia can not only relieve the patient's pain, and carry out postoperative
rehabilitation exercises as soon as possible [6]. It can inhibit the body’s stress response
caused by pain and reduce ischemia to vascular endothelium and tissues. Damage reduces the
release of procoagulant substances and ultimately plays a role in preventing thrombosis [7].
With the development of medical imaging technology, more and more images are
applied in medicine. How to make better use of these images for medical services is a hot
topic that various researchers are exploring. Recently, many vascular segmentation methods
have emerged, but many algorithms have some limitations in engineering applications. It is

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because that the accuracy of algorithm can’t be guaranteed and the clinical practicalities are
not good enough [8-9]. Many algorithms can’t be applied in practice due to time and space

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complexities themselves. Studies have shown that the adaptive algorithm can be applied
effectively in the vascular segmentation of CT images [10]. Some studies have proposed the
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adaptive segmentation was for the spectral information of different regions including the
segmentation method based on seed points, to achieve the segmentation of image sequence.
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However, the segmentation accuracy is directly related to the selection of the size of target
block, and the segmentation is featured with complex operation and low efficiency [11-13].
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Therefore, this study puts forward the improved adaptive algorithm, which can be applied
better in the vascular segmentation by utilizing the characteristics of vascular area rather than
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just the characteristics of one point of blood vessel. From that, the algorithm can possess
good stability and detect the vascular branch, so vascular segmentation shows the
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characteristics of itself and was different from other algorithms.

As an auxiliary analgesic method, electroacupuncture has achieved remarkable results in
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recent years. For patients with total knee arthroplasty (TKA), preoperative electroacupuncture
treatment can reduce the consumption of opium analgesics during surgery [14]. At the same
time, reduce the adverse reactions caused by analgesic drugs, enable patients to go to the
ground as early as possible, and reduce the length of hospitalization. The effective
acupuncture can dredge meridians and regulate [15]. The operation of blood in the body
promotes faster blood flow and lower blood viscosity, which effectively prevents the
formation of DVT after TKA. The femoral nerve block (FNB) is another analgesic method
after TKA. Some studies have compared it with the epidural group and the intravenous
analgesia group. The results show that the pain score of the femoral nerve block group is
lower than that of the control group. A multicolor randomized controlled study compared the
effects of continuous femoral nerve block analgesia and venous analgesia [16]. The results of
the study show that FNB can promote patients’ early rehabilitation training and improve the
visual analog scale (VAS). FNB can reduce the chance of DVT after TKA, which may be
related to relieving postoperative pain, inhibiting the body’s stress response, completing limb
training activities and speeding up blood flow.
Although the fully automatic segmentation algorithm has achieved a lot of research
results on multimodal medical image segmentation and has shown its excellent segmentation
performance [17], some algorithms are difficult to be applied in clinical practice due to their
complexities and low efficiencies. Therefore, medical image segmentation still faces great
challenges. This study improves complex-valued fully convolutional neural network
(RV-FCN) based on conditional random field (CRF) algorithm, proposes an improved
RV-FCN+CRF adaptive algorithm to segment CT images of DVT patients after TKA, and
compares and analyzes the image segmentation effects with FCN and RV-FCN single
algorithm. In addition, electroacupuncture combined with continuous femoral nerve block are
adopted to compare with the single treatment method, so as to explore the effective plan for
the prevention of lower extremity DVT after TKA, which provides a reference for clinical
decision-making.

2 CT image-guided analysis based on an adaptive algorithm

2.1 Improved adaptive algorithm

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The residual network can solve the problem of deep network gradient dispersion and
network degradation. Its essence is to use the identity mapping method to degrade the

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network into a shallow network [18]. The reason of the deep network is difficult to train is
that the network layer cannot directly fit the identity mapping function.
M ( x) = x
-p (1)
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If the network structure is designed as H(x) = F (x) + x, then it is converted to the
problem of learning a residual function F (x) = H (x) -x. When F(x0) is formed, an identity
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map of H (x) is formed, and it is easier to fit the residual structure. The expression
corresponding to the first layer is as follows.
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M ( x ) = w 2 σ ( w1 x ) (2)
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After getting the function value of the first layer, use a shortcut and the second
activation function Relu to obtain the output y. The expression is as follows.
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J = M ( x,{wi}) + x (3)

In probability theory and statistics, the probability distribution is a mathematical

function that provides the probability of different possible outcomes of an experiment.
Different from the MSR framework, the MGS framework uses group sparseness to construct
the adjacency matrix of samples, to obtain a higher level of the sparseness of the sample
matrix. For the given data set, it obtained the sparse coefficient matrix of the sample, the
MGS framework solves the objective function shown in equation (4).
n
1
min ∑
2
xi − X Pi + χ P 2,1 (4)
i =1 2
P 2

It used the obtained sparse matrix to describe the local information of the data set and
construct the local sparse degree. Then the local sparseness can be expressed as equation (5).
1
QL (w) = ∑
2 i, j
(Pi − Pj )2 Pij (5)
 The optimization goal of local sparseness is to find the projection matrix to minimize the
distance between local points. For deriving equation (2) through a simple formula, equation
(6) can be obtained.
1
QL (w) = ∑
2 i, j
Pij (w T xi − w T x j ) 2

1
= ∑
2 i, j
Pij (w T xi − w T x j )(w T xi − w T x j )

1 T
= w ( ∑ Pij ( xi − x j )( xi − x j )T ) w
2 i, j
(6)
1 T
= w ( ∑ Pij (x i xi T ) + ∑ Pij (x j x j T ) − 2∑ Pij (x i x j T )) w
2 i, j i, j i, j

1 T
= w (2 XDX T − 2XSX T）w

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2
= w T X (D − S)X T w

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Where D is a diagonal matrix, and each element of it is the row sum of the sparse matrix.
The local divergence can be expressed as:
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Q L (w ) = w T X L X T w (7)

After finding the local sparse matrix S, define the non-local sparse matrix is:
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PijN = 1 − Pij (8)

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Correspondingly, the non-local divergence can be expressed as:

1
QN (w) = ∑ (1 − Pij )2 (mi − m j ) (9)
ur

2 i, j
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When the training data set trains the network model, the neural network learns the
corresponding sample data. The learning process is essentially learning the distribution of
data, but when the training data set is different from the test data set, the generalization ability
of the network will also be greatly reduced. When the stochastic gradient (SGD) of the
training network model drops, the data distribution of each batch of training is different, the
network needs to learn during each iteration. It can adapt to different distributions this
process will greatly reduce the training speed of the network [19]. At the same time, as the
number of network layers deepens, the difficulty of training the network also increases, and
the convergence speed of the network becomes slower and slower. To address these problems
in the network, the method of batch regularization (BN) is used. The network is processed by
the batch regularization method, a higher learning rate can be applied to the training process.
When the value of the learning rate set by the network is large, the decay rate of the learning
rate will also be very large. The regularization algorithm has the characteristics of rapid
convergence. At the same time, batch regularization also has the characteristics of improving
the generalization ability of the network and normalizing the network layer. The specific BN
formula is as follows:
 1 n
n
f n (t ) = lim
h →0 h n
∑ (−1) m
  f (t − mh) (10)
m=0 m
 t −a 
 h 
1  
Γ (v + 1)
a Dt f (t ) = lim v
G v
h→0 h
∑ (−1)
m=0
m

m !Γ (v − m + 1)
f (t − mh ) (11)

 ∇au 
− div  a  + λe (u − u 0 ) = 0 (12)
 ∇ u + p
 
The forward transmission process of the black regular network layer is shown in the
following formula
b e s t ( g ) = m in fit j ( g ), j ∈ 1, ..., I (13)

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fiti − worst ( g）
mi ( g ) = (14)
best ( g ) − worst ( g )

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Fi d (t ) = ∑ j∈K rand j Fijd (t )
-p (15)
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2.2 Analysis of CT image-guided model
The dual-tree complex wavelet transform has the advantages of translation invariance
lP

and good direction selectivity. After decomposing the dual-tree complex wavelet transform,
the multi-spectral image and the panchromatic image, combined with the sparse
na

representation, can obtain a clearer image of the ground features. The principle of the image
fusion algorithm based on the combination of dual-tree complex wavelet transform and
ur

sparse representation is that dual-tree complex wavelet analysis is used to decompose the
multispectral image and panchromatic image to be fused to obtain multiple decomposition
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coefficients. Low-frequency sub-bands representing approximate coefficients are fused using

a sparse representation method, and high-frequency sub-bands representing detail coefficients
used local energy based on local similarity measures to take the large and weighted average.
The combined method fuses the high-frequency sub-bands in 6 directions in turn. The
high-frequency sub-band after the fusion is the double-tree complex wavelet transform to
obtain the final fusion image.
As showed in Figure 1, it is a flow chart of the algorithm for fusing CT image and
panchromatic image by combining the dual-tree complex wavelet transform (DTCWT) and
sparse representation (SR).
 Low pass High frequency
↓3
Low pass Filter h0(n) Subband A(j+1,1)
↓2 High pass Low frequency
filter h0(n)
↓4
Filter h1(n) Subband D(j+1,1)
Low pass High frequency
↓3
Low pass Filter h0(n) Subband D(j+1,2)
↓2
filter h0(n) High pass Low frequency
↓4
A(j,1) Filter h1(n) Subband D(j+1,3)
D(j,1)
Low pass High frequency
↓3
Low pass Filter g0(n) Subband A(j+1,2)
↓2
Filter g0(n) High pass Low frequency
↓4
Filter g1(n) Subband D(j+1,4)
Low pass High frequency

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↓3
Filter g0(n) Subband D(j+1,5)
Low pass

ro
↓2
filter g1(n) High pass Low frequency
Filter g1(n) ↓4
Subband D(j+1,6)
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Figure 1 Flow chart of fusion algorithm combining dual-tree complex wavelet transform and
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sparse representation
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For the evaluation of image fusion, one is a subjective evaluation, which is to give a
good and bad evaluation of the image fusion result of a specific scene through the visual
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observation of professionals. This method is highly dependent on people and the evaluation
result is difficult to standardize. Another method is an objective evaluation, which evaluates
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the resulting fused image based on a series of indicators and based on the values of these
indicators. This method is objective and comprehensive, but the evaluation of the fused
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image using a single indicator is too one-sided, and different parameters need to be selected
multiple indicators of can be used to evaluate an image more accurately [20]. The objective
evaluation method of image fusion is based on the purpose of image fusion, and the specific
evaluation parameters are selected according to the application purpose, the relevant
parameters of the fusion image and the source image are calculated. The quality of the fusion
image is measured by the evaluation result. Evaluation methods for image fusion can be
divided into three types according to the type of indicators.
We used two one-dimensional DTCWT to realize the two-dimensional two-tree complex
wavelet transform of the image. One-dimensional DTCWT transformation is performed on
each row of the image, and then one-dimensional DTCWT transformation is performed on
each column. Figure 2 is a schematic diagram of the image undergoing a two-dimensional
DT-CWT decomposition.
 Step 1 Step 2 Step 3 Step 4

Feature vector

CT dataset Pictures A
B
C1:6@ C
24*24
PET dataset Classifier
+ +
S1:6@
12*24
a b c
CT/PET
dataset M1:6@
12*12

Figure 2 Model process

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Through data processing, three modal samples are obtained, each of which is 3000 cases

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of data, 2 types of targets, which are divided into a test set and a training set according to a
certain ratio, 2000 and 1000 cases respectively, and constructed Corresponding to the binary
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label. The three modal data and labels are input to the convolutional neural network, and the
parameter migration method is used to build a LeNet-5 model. By fine-tuning the CNN
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model, the three single-modal CNN fully connected layers are extracted separately, using the
random function, while following the fusion rules where the corresponding positions are
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unchanged. It fully connected feature maps after the fusion, and then classify through the
activation function to the classification results and compare them with pre-set tags are
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compared to obtain the identification results of vascular image segmentation.

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3 Model-guided electroacupuncture combined with a continuous femoral nerve block to

prevent deep vein thrombosis after total knee arthroplasty
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3.1 Research objects and equipment drugs

Patients, who would be operated TKA in hospital, were selected as the research objects,
and all patients met the screening criteria. The final patients were randomly divided into four
groups: intravenous controlled analgesia group (PCIA group), femoral nerve block controlled
analgesia group (PCNA group), intravenous controlled analgesia combined with
electroacupuncture treatment Group (PCIA + EA group), femoral nerve block combined with
electroacupuncture analgesia treatment group (PCNA + EA group). Comprehensive
preoperative evaluation of all study subjects and patients with severe mergers is invited to
consult with relevant departments. All patients control the preoperative blood pressure below
160/100mmHg for the preoperative patients with hypertension. It took corresponding
measures for diabetic patients to control the blood glucose within an appropriate range. All
patients should actively cooperate with the completion of preoperative preparation and
routine fasting of water. The main drugs and equipment are as follows: Reg again (25mg*6
capsules), Gabapentin (120mg*30 caps), Hydrochloride (15ml: 0.2g*10 sticks), Vitamin
B24(4ml: 1mg), Dexamethasone (3.0ml: 15mg), Sodium chloride (25ml: 120mg) and Macon
alamin (5ml: 2.5mg).
3.2 Experimental methods
At the end of the operation, the patient took the supine position, and the assistant helped
him to present the affected limb with the abduction and external rotation angle, fully exposed
the groin area, using a portable color two-dimensional ultrasound system, high-frequency
linear array probe. The long axis of the probe is perpendicular to the longitudinal axis of the
thigh. It will find the femoral artery, move the probe to the head end to visualize the femoral
artery, the femoral vein is usually located inside the femoral artery, and the femoral nerve is
located outside the femoral artery, usually in the groin triangle. When the ultrasound image
clearly shows the femoral nerve, it can inject a small amount of sodium chloride solution.
The femoral nerve can be seen in the low echo area formed by diffusion. At this time, the
nerve block needle is quickly placed in the femoral sheath, and the catheter is inserted along
the block needle, and slowly injects 20ml of 0.25% replaceable hydrochloride and exit the
puncture needle. The catheter was fixed and the skin around the puncture site was sutured and

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connected to an analgesic pump. As showed in Table 1, it is the parameter setting of the
experimental step.

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Table 1 Experimental steps
Steps Explanation
1
2
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The PCA algorithm is used to reduce the entire data set to a certain dimension
The sample-set X is divided into c sample subsets according to category labels.
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3 It used supervised sparse framework to find the adjacency matrix S of the training set
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4 It used equation to find the sparse reconstruction coefficient Si for each sample
5 The sparse reconstruction coefficients are arranged into an adjacency matrix S.
6 It used the S matrix obtained in step 3 to construct a local Laplace matrix
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7 It used words to project the entire data set into a low-dimensional space
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4 Results and analysis

4.1 Analysis of adaptive CT image guidance results
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After the RV-FCN network model and CRF post-processing method, thrombus location
can be automatically segmented from CT images of deep venous thrombi in lower extremities.
Figure 3A is the original CT image of deep vein thrombi in lower extremities, Figure 3B is
the CT image of deep vein thrombi in lower extremities based on RV-FCN segmentation, and
Figure 3C is the CT image of deep vein thrombi in lower extremities based on RV-FCN+CRF
segmentation in this study. Thus, RV-FCN+CRF can automatically segment the location of
thrombus, and the segmentation boundary is clearer than that of the RV-FCN single
algorithm.
 of
A B

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-p
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na
ur
Jo

C
Figure 3 The CT images of deep venous thrombi in lower extremities based on the improved
adaptive algorithm segmentation.
(Note: A is the original CT image; and B and C are the CT images based on RV-FCN
segmentation and RV-FCN+CRF segmentation, respectively.)

Figure 4 is a comparison experiment result between the method proposed in this paper. It
can be seen from the results that the MSD value in the method proposed in this paper is the
smallest compared with the other four methods, can extract the boundary information of the
thrombus more accurately, and it has relatively good accuracy of thrombus segmentation, and
has the highest DICE value of 95.96%. The method proposed in this paper can automatically
segment the thrombus region in CT images more accurately. Based on the RV-FCN network
model, the CRF method is used to further optimize the thrombus segmentation results and
compare it with the FCN method and the RV-FCN method. The experimental comparison
results are shown in Table 2. In the comparative experiment, with the increase of batches of
Epoch, each network model was trained and tested, and the accuracy rate distribution map of
CT image segmentation was obtained, as showed in Figure 5 respectively. The results of the
chart show that the CRF method is used as post-processing. The RVD value is slightly higher
than the value of the RV-FCN network model, the other indicators are superior to the above
two methods, thereby further improving the accuracy of thrombus image segmentation.
120
VOE
100 RVD
ASD
80 MSD
DICE
Percent

60

40

20

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0

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-20
U-net CFCN Literature1 Literature2 RV-FCN
Methods
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Figure 4 Comparison of CT image segmentation results of different models
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Table 2 Comparison of CT image segmentation results by CRF method
Methods VOE RVD (%) ASD (mm) MSD (mm) DICE (%)
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(%)
FCN 16.54 -13.07 4.10 77.77 99.91
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R V-FCN 6.56 0.37 0.65 5.84 115.15

RV-FCN + CRF 6.28 0.65 0.56 5.70 116.08
ur

100
(a)
80
Jo Accuracy

RV-FCN+CRF
60
RV-FCN
FCN
40

20

0 20 40 60 80 100 120 140

100 (b)
80
Accuracy

RV-FCN+CRF
RV-FCN
60
FCN

40

20
0 50 100 150 200 250
Number of iterations

Figure 5 Comparison of the accuracy of each algorithm on the training set and test set

It is particularly important that effective postoperative analgesia reduces patients’

bedtime, increases active and passive exercise time, and plays a role in actively preventing
lower limb deep vein thrombosis. Different current frequency will produce different analgesic
effects. The intensity of the electroacupuncture is subject to the patient's tolerance. As shown
in Figure 6 below, there is a large difference in the frequency of electroacupuncture at
different time points, as well as a large difference in the frequency of electroacupuncture
among different groups. Because different electroacupuncture frequencies produce different
endogenous analgesic substances, the use of sparse and dense waves can prevent patients
from producing electroacupuncture tolerance. Some studies have shown that acupuncture at
different points. It also produces different clinical effects. It can not only speed up blood flow
and improve blood circulation, acupuncture points can effectively increase local blood flow
and oxygen supply, and improve lower limb ischemia. It is of great significance to prevent
the formation of DVT after TKA.
8
Actual Value
7 PCIA
PCNA

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6 PCIA+EA
PCNA+EA
EA

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5
Values

3
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2
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0
1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:0010:0011:0012:0013:0014:0015:0016:0017:0018:00
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Time
Figure 6 Quantitative index values
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To achieve the best treatment effect in this study, all acupuncture treatment operations
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are performed by the same senior acupuncture physician [21-22]. High technology is easy to
damage the femoral artery and femoral vein. To achieve the best postoperative analgesia
treatment effect in this study, all femoral nerve catheterization treatment operations are
performed by a senior anesthesiologist under the guidance of ultrasound [23]. The
experimental results are shown in Figure 7. Based on the receiver operating characteristic
curve (ROC), the algorithm proposed in this study has relatively high sensitivity in CT image
segmentation with the area under the curve (AUC) value of 0.973.
 1.0

0.8

Sensibvity
0.6

0.4
Manual Segmertation
Initial Contour + CV model|
The proposed method
0.2 P

0.0
1.0 0.8 0.6 0.4 0.2 0.0
Specifcity

Figure 7 Classification results in ROC curve

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4.2 Model-guided electroacupuncture combined with continuous femoral nerve block on
the results of deep vein thrombosis after total knee arthroplasty

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The comparison of gender and intraoperative urine volume of the four groups of patients
are shown in Figure 8. The results were not statistically significant and were comparable. Due
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to the particularity of the interventions, it is impossible for the research object and the
treatment staff The blind method is implemented, so this test mainly sets the blind method for
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the data analysts.
70
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Number of cases
DVT occurs
60 DVT did not occur
Incidence of DVT (%)
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50 50 50 50
50 48
43 44
40
Numbers

36
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30 28
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20
14 14
12
10 7 6
4
2
0
PCIA PCNA PCIA+EA PCNA+EA
Group
Figure 8 Comparison of the incidence of DVT on the 7th postoperative day in four
groups

Compared with PCIA group, PCNA group, and PCIA + EA group, PCNA + EA group
had lower platelet counts on the 7th day after the operation, the difference was statistically
significant. Compared with preoperative, platelet counts in each group on the 1st day after
operation were elevated. Compared with the first day after the operation, the platelet count
decreased in the PCIA + EA group and PCNA + EA group on the 7th day after the operation,
the difference was statistically significant (P <0.05) as shown Figure 9.
 1800

1700

1600

1500

-1800 -1700 -1600 -1500 -1400 -1300

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Figure 9 PLT before and after an operation in four groups of patients (n = 50, (x ± s))

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As showed in Figure 10, compared with the PCIA group, the D-dimer index decreased
on the 7th day after the PCIA + EA group and PCNA + EA group. The D-dimer index
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increased on the 1st and 7th day after the operation, and the difference was statistically
significant. Compared with the 1st day after the operation, the PCIA group and the PCNA
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group had a D-Dimer index increased, the difference was statistically significant (P <0.05).
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-0.5 PCIA+EA
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PCNA+EA
PCIA
PCNA
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Values

-1.0
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-1.5

0 5 10 15 20 25
Number of frames

Figure 10 Comparison of D-dimer index before and after an operation in four groups of
patients

The results of this study showed that the incidence of DVT in the PCIA group. PCNA
group, PCIA + EA group, and PCNA + EA group were 28%, 14%, 12%, and 4%, respectively.
For patients who did not take preventive measures after TKA. The incidence rate is
40.0%~62.0%, suggesting that effective treatment should be taken to prevent the occurrence
of DVT after TKA. This group of results shows that continuous femoral nerve block can
effectively prevent the occurrence of DVT. The incidence of DVT after surgery has further
decreased. This study further compared the differences in hemorheology indicators.
Compared with the first day after surgery, the whole blood viscosity of PCNA + EA and
PCIA + EA group was lowered and the red blood cell aggregation index was significantly
reduced on the seventh day after surgery. Blood hypercoagulability is one of the important
factors of thrombosis. More and more studies have shown that improving blood viscosity can
effectively prevent thrombosis, and the lower incidence of DVT of PCNA + EA may be
related to this.
Compared between the two groups of patients, patients in the group improved
significantly compared with the patients in group. As showing in Figure 11, it shows that in
the long-term treatment effect and group O is better than group P.

Sensory score 0.0 1.3 2.6 3.9 5.22.3 4.6 6.9 9.2 0.0 1.3 2.6 3.9 5.2
0.0 2.5 5.0 7.5 10.0
Effective score Sensory score

Sensory score 5.6

5.1
4.2
3.4
2.8

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1.7
1.4
0.0
5.2 5.2
Effective score
3.9 3.9

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2.6 2.6

1.3 1.3

0.0 0.0
9.2
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Total score 9.2
Total score

6.9 6.9

4.6 4.6
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2.3 2.3
5.2 5.2
VAS (mm)
3.9 3.9
VAS (mm)

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2.6 2.6

1.3 1.3

0.0
10.0 0.0
PPI 9.9
7.5
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6.6
PPI

5.0
3.3
2.5
0.0
0.0
1.4 2.8 4.2 5.6 0.0 1.3 2.6 3.9 5.22.3 4.6 6.9 9.2 0.0 1.3 2.6 3.9 5.2 PPI
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Sensory score Effective score Total score VAS (mm) PPI

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Figure 11 SF-McGill scores before and after treatment in two groups

This section uses a prospective randomized control method, and combined with
continuous femoral nerve block technology to study the prevention and treatment effect of
DVT after TKA. It effectively integrates western medicine, providing a new strategy for the
development of multi-mode prevention and treatment strategies.

5 Conclusion
In this paper, adaptive segmentation of CT images for various modalities and parts is an
important technical means for the subsequent completion of diagnosis and treatment and
disease management. Eventually, the segmentation results need to be further completed to
complete tasks such as image processing and organ anatomy analysis. The idea of a cascaded
convolutional network is applied to the evaluation and analysis of CT images with deep
venous thrombosis before surgery. To ensure the full use of the contextual spatial information,
the fusion of the upper and lower layers of image information to enrich the feature expression,
the introduction of a general image similarity function on the loss function to solve the
medicine Multi-target category imbalance in the image. It observed the incidence of
postoperative lower limb deep vein thrombosis (DVT). Electroacupuncture combined with
continuous femoral nerve block can reduce the incidence of DVT after TKA, and it has
obvious advantages in the multi-mode prevention of DVT. Compared with the preoperative
period, the platelet counts of the four groups were increased on the first day after the
operation, and the difference was statistically significant.

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Credit Author Statement
Xiangrong Guo: Conceptualization, Writing - Original Draft

Fen Gui: Software, Writing - Review & Editing

Meiqin Guo: Investigation, Formal analysis

Junhong Peng: Data Curation

Xianjun Yu: Methodology, Supervision

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Abbreviations
CNNs: convolutional neural networks
CT: Computed Tomography
DTCWT: dual-tree complex wavelet transform
DVT: Deep Vein Thrombosis
FNB: Femoral Nerve Block
RCT: randomized controlled trial
SR: sparse representation
VAS: visual analog scale

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