Clincal Research On Meridian-Muscle Syndrome Differentiation In Knee Osteoarthritis

Objective:To clarify the physiological and pathological features of the meridian-muscle syndrome by using modern methods of TCM theory so as to improve the clinical diagnosis technique for this kind of diseases and promote the normalization and standardization of the meridian-muscle therapies clinically. In this paper, by studying the clinical features and regularities of meridian-muscle syndrome in knee osteoarthritis (KOA), the TCM knowledge of this disease was further expanded; the retrospective study on the clinical and imaging features of Foot-Yangming meridian-muscle syndrome of KOA was performed for an initial summary so as to perfect the TCM external treatment for this disease and deeply verify some general conclusions from classical TCM theory, thereby providing some evidences and effective interpretations for traditional meridian-muscle theory on perspectives of modern evidence-based medicine and medical imaging.Method:The data of the basic information and related symptoms and signs of KOA patients who met the inclusion criteria were collected, according to the syndrome questionnaire and lesions distribution table of these patients, an analysis was performed on their data so as to describe their KOA meridian-muscle distribution; a correlational research was performed among the imaging features, clinical characteristics, visceral syndrome law for various meridian-muscle syndromes; then the most common seen Foot-Yangming meridian-muscle syndrome in this study was selected as a typical condition for a retrospective research based on imaging and clinical features of patellofemoral relationship. The imaging and clinical features of patellofemoral relationship in Foot-Yangming meridian-muscle syndrome was concluded by using SPSS19.0software to establish a database, and using chi-square test, Student’s t test, univariate correlation analysis.Results:In this study, a total of180patients (208knees) were included. The study found that:1. There were31cases of KOA patients with single Foot-Yangming meridian-muscle syndrome, accounting for14.9%of all meridian-muscle syndromes, this syndrome accounted for the highest incidence of all single meridian-muscle syndromes. While Foot Yangming-Three Yin syndrome had the highest incidence in all meridian-muscle syndromes,37cases, accounting for17.8%of all meridian-muscle syndromes.2. The gender distribution of the common meridian-muscle syndromes found by this study had significant difference, by chi-square test, the results of Pearson Chi-Square showed that x2=12.07, P<0.05.3. In all180patients, the youngest was45-year-old, the oldest was75-year-old, their average age was59.70±9.68(years); The ages were divided into3sections, by chi-square test, the theoretical frequencies of13cells (43.3%) were less than5, the minimum theoretical frequency was2.91, the results of Fishers exact test showed that χ2=78.899, P<0.05, suggesting that the age distribution of all meridian-muscle syndromes found had significant difference. The Student’s t test between disease syndrome duration of and meridian-muscle syndromes showed that t=-3.221, P=0.001, suggesting that the meridian-muscle syndromes trend to complex with the increase in duration.4. The imaging severity grading of single meridian-muscle syndrome mainly distributed in grade0, grade Ⅰ and grade Ⅱ, the complex meridian-muscle syndrome mainly distributed in grade Ⅲ, grade Ⅳ; The results of the rank sum test performed for common meridian-muscle syndromes (Foot-Yangming meridian-muscle syndrome, Foot Yangming-Taiyang meridian-muscle syndrome, Foot Yangming-Three yin meridian-muscle syndrome, Foot Taiyang-Three yin meridian-muscle syndrome) showed that U=58.776, P <0.05, suggesting that the imaging severity grading distribution of all these meridian-muscle syndromes had significant difference. The meridian-muscle syndrome differentiation and imaging lesion classification were verified by chi-square test, the results showed that the theoretical frequencies of26cells (65.0%) were less than5, the minimum theoretical frequency was1.38. The results of Fisher’s exact test showed that χ2=203.396, P<0.05, suggesting that the meridian-muscle syndrome differentiation and imaging lesion classification for KOA diagnosis had significant difference.5. The difference knee function in single meridian-muscle syndrome and that in complex meridian-muscle syndrome was statistically significant, the results of Student’s t test showed that t=4.159, P<0.05; suggesting that the knee function score decreased with the increase in the number of meridian-muscle lesions, they were negatively correlated.6. The most common TCM symptoms for KOA patients in this study were healthy energy deficiency and evil excess: the main factors for deficiency syndrome were kidney deficiency, liver deficiency and Yang deficiency. The main factors for pathogenic syndrome were blood stasis, Qi stagnation, phlegm. The lesions mainly occurred in kidney, liver and spleen. The single meridian-muscle syndrome was mainly associated with blood stasis, phlegm and Yang deficiency, while the complex meridian-muscle syndrome was mainly associated to kidney deficiency, spleen deficiency and liver deficiency, in addition, the degradation and exhaustion of bones and muscles in advanced stage of meridian-muscle syndrome were closely associated with liver and kidney deficiency.7. In early stage of KOA patients, they mainly had chief complaints such as perceived pain, focal tenderness; in the middle stage of KOA patients, they mainly had palpable nodular cord-like lesions, some serve patients even had superficial varicose veins and popliteal cyst; in the advanced stage of KOA patients, they mainly had changes in skin color, pigmentation and other symptoms.8. The second part of the clinical study was performed for31cases of KOA patients with Foot-Yangming meridian-muscle syndrome, the results showed that some radiographic parameters of patients with Foot-Yangming meridian-muscle syndrome and that of blank group were significantly different:in compassion of patellofemoral indexes between both group, the average ratio of Foot-Yangming meridian-muscle syndrome group was1.50±0.24, while that of blank group was1.03±0.19, the results of Student’s t-test showed that P<0.05, suggesting that there were significant difference between these two groups; in compassion of lateral patellofemoral angle between both group, the average angle of Foot-Yangming meridian-muscle syndrome group was6.31±1.58, while that of blank group was9.11±1.78, the results of Student’s t-test showed that P<0.05, suggesting that there were significant difference between these two groups.Conclusion:1. There are various meridian-muscle syndromes in KOA patients, these syndromes are closely corrected to the ages, durations, knee function scores of these patients.2. The distributions of the meridian-muscle syndromes are closely corrected to the imaging changes in KOA patients. If the single meridian-muscle syndrome of a patient developed into complex meridian-muscle syndrome, his/her imaging changes would occur at the same time.3. The main TCM symptoms of KOA patients are healthy energy deficiency and evil excess, in which, the main factors for deficiency syndrome are kidney deficiency, liver deficiency and Yang deficiency, and the main factors for pathogenic syndrome are blood stasis, Qi stagnation, phlegm, in addition, the degradation and exhaustion of bones and muscles in advanced stage of meridian-muscle syndrome were closely associated with liver and kidney deficiency.4. The Foot-Yangming meridian-muscle syndrome of KOA mainly occurred in the patellofemoral joint, the patellofemoral relationship disorder is one of lesion characteristics in Foot-Yangming meridian-muscle syndrome.