Osteoarthritis Of The Knee Tendons Dialectical And Gait Analysis Study

Osteoarthritis is a common dieasease in the aged people whose life quality is greatly degraded. Some people are even disabled by this disease. It always occurs at major joints bearing weight, especially at articulation of knee, and biomechanical factors are the most certain pathogeny. Due to trauma,chronic injury and contraction of external evils, the soft tissue around the knee joint alters pathologically, which induces the stress imbalance inside the joint. Finally, cartilage injury and osteoarthritis develop.Hyperosteogeny on the border of knee joint is always found in the patient with osteoarthritis. Thus osseous alteration was over emphasized and the treatment was aiming at osteophyte. However, the therapeutic effect was not good enough and the clinical sign was not in accordance with the osseous alteration. Therefore, some doctors have recently treated osteoarthritis with various channel sinew therapy according to the channel sinew theory whose principle is setting the bone to soften the sinew and treating sinew to set the bone. This clinically proves that channel sinew alteration plays an important role in the development and progression of osteoarthritis.Channel sinew theory originates from the Internal Classics. In article of Channel Sinew from Spirit Piviot, the location and syndrome traits of 12 channel sinew are descripted in detail and it sets up the principle that is locatting the region with pain as acupoints and feeling the arrival of qi. Later doctors interpreted and developed the system of channel sinew theory. Channel sinew is the govenor to restrict bones; it makes sure that joint is functioning well;it is the rigidity and the wall. All the above means that channel sinew is able to connect, restrict and protect the bones. Muscle spasm, tenon flaccidity and tendon atrophy express as pain and movement disorder along the region of channel sinew. It is always diagnosed with palpation and knotted sinew point where the pain is and pressure on this region can relieve the pain. This feeling needs long-term exercise. It is treated with various needle method to unfasten the knot and remove the focus. Active exercise of Anqiao (massage)is paid much attention. The modern doctors develop the channel sinew theory with modern anatomy and biomechanics.The anatomic entity of channel sinew is now commonly thought to be similar to the soft tissues, including muscle, tendon, ligament, fascia, synovial membrane and part of nerves. It is the summary of the physiology and pathology of desmography, myography and the attached tissues with 12 force lines (which is closely related to the channel sinew).However, systematic study on the correlation between osteoarthritis of the knee joint and the channel sinew alteration around knee has not been seen insufficient. Limited studies are reported on the channel sinew syndrome differentiation and channel sinew focus of oesteoarthritis in the knee joint. Furthermore, objective measurement of biomechanical alteration indued by channel sinew alteration in the knee joint has not yet been reported. This greatly restricted the widespread application of channel sinew therapy in the diagnosis and treatment of osteoarthritis in the knee joint.This study is based on the channel sinew syndrome differentiation in diagnostics of Traditional Chinese Medicine. Pathological alteration and syndrome differentiation of osteoarthritis are objectively researched with gait analysis and the combination of human dynamics and kinetics, which might be helpful for the diagnosis and treatment.This study is consisted of two parts. In the first part the relation bewteen osteoarthritis and the channel sinew alteration as well as channel sinew focus are investigated. In the second part, gait analysis with osteoarthritis is researched and objective study on syndrome differentiation is taken with modern biomechanics.The first part of this paper is on investigation about osteoarthritis and the channel sinew alteration as well as channel sinew focus. It is consisted of theoretical study and clinical study. In the theoretical study, ancient literatures are reviewed and summaried with physiology, pathology and treatment. Then the relation bewteen osteoarthritis and the channel alteration is studied. The question that how channel alteration of knee joint causes abmornal force line in the lower extremities and imbalance of stress distribution inside the the knee joint is researched with biomechanics, which is a difficult and unkown region by now. Study on channel sinew alteration and nosogenesis and signs of osteoarthritis proves that osteorthritis is a kind of channel sinew diseases, which provides evidence for theoretical basis of channel sinew therapy. In clinical study, 70 cases of patients with osteoarthritis are investigated on syndrome differentiation and frequency of focus along channel sinew region. Although acute injury and contraction of wind-cold evil can induce channel sinew alteration in Foot Taiyang, no single type of syndrome is found in this channel sinew. The ocurrence of osteoarthritis is resulted from over-action and chronic injury due to extension and flexion, outward rotation and inward rotation of the knee joint. Due to anatomic and dynamic reasons, the pathological change in Foot Yangming is the most common and so treatment to this channel sinew needs to be emphasized. No single syndrome type is found in Foot Taiyang channel sinew, and complicated pathology is seen. Pathological change in Foot Taiyang Channel Sinew is always complicated with that in Foot Yangming, Foot Shaoyang and Foot Sanyin Channel Sinew. For these channel sinew, combined treatment is need. The frequency of focus in channel sinew is also measured statistically. All the results above can be the important reference for treating osteoarthritis with channel sinew therapy.The second part is the gait analysis of patients with osteoarthritis. The disorder of joint movement is expressed as abnormality in gait and so observance on the gait of patient is helpful for the evaluation of the seriousness of channel alteration. Therefore, the syndrome types of osteoarthritis are researched objectively with biomechanical technique of gait analysis. It is also consisted of theoretical and clinical study. In theoretical study, gait analysis and apparatus are briefly introdued and the application of gait analysis is reviewed and analysed. Problems are pointed out. Plan of this study is presented.Three clinical trials are carried out with case-control method. In trial 1, pressure distribution at the sole and the vertical rebound forece at each period are researched. It found that patient with osteoarthritis has mechanic abnormality in that the time of single foot bearing force is shortened with decreased buffer time and buffer force coefficient, which provides evidence for the mechanism of biodynamic change induced by channel alteration. Taking half power point in engineering as referrence, then buffer force coefficient is innovated. The result of this study can be the referrence for the diagnosis and treatment of osteoarthritis. In trial 2, gait of patient with osteoarthritis is studied. It is after trial 1 and it put emphasis on the channel sinew alteration. It investigates different gait chararteristics of channel sinew in Foot Yangming, Foot Shaoyang, and Foot Sanyin. The result shows that the same medial osteoarthritis with differernt channe sinew alteration varies in the signs and symptoms. Gait indexes are summaried for reference of channel sinew syndrome differentiation. Trial 1 and 2 fills the reseach blank in this domain domestically. The plan and method of trial 2 has not been seen internationally. In trial 3, observance is made on clinical therapeutic effect of sinew adjusting manipulation combined with function exercise treating osteoarthritis. With criteria of commonly accepted JOA and gait index, the therapeutic effect in trial group is more significant than that in control group. Finally the view of point that osteoarthrtis is a kind of channel sinew alterations is proved and the gait analysis can be applied in diagnosis and evaluation of this disease and objective study of channel sinew syndrome differentiation.This study find out that as follows:1 Channel sinew focuses are common in osteoarthritis and causes biomechanical change. Therefore, constant pain, multiple channel sinew focus and biomechanical change can be thought to be prophase or super-prophase of osteoarthritis, no matter osseous change exists or not. This can be of great help for early diarnosis.2 Different channel sinew alteration varies in gait characteristics, which is useful for diagnosis and syndrome differentiation of channel sinew disease.3 Channel sinew therapy is effective for the treatment of osteoarthritis and gait analysis can be applied for the evaluation of therapeutic effect.This study has some innovative points as follows: 1 Osteoarthritis is a channel sinew disease and syndrome is differentiated. Then objective study on syndrome differentiation is presented. It is an innovation in acdemics.2 Channel sinew disease is diagnosed with conventional palpation. Gait analysis is presented and adopted in diagnosis and objective study, which is an innovation in techniques.3 Mechanical traits and gait distribution of osteoarthritis are studied with biodynamics and foot pressure measurement. Buffer force coefficient is presented and studied by taking referrence to half power point in mechanics. It is also an innovation in techniques.