| Patellofemoral joint is the main anatomical structure that supporting flexion and extension of knee joint,and the joint is composed of patella and trochlea of distal femur.The wear and degeneration of patellofemoral articular cartilage can be caused or induced by degeneration,trauma and other factors,which can lead to degenerative arthritis of the local articular compartment of the knee joint.Patellofemoral arthritis is a part of senile knee arthritis,which can be characterized by local or extensive pain and limited walking,anatomical morphological changes of the knee joint may occur in severe cases.Clinical examination revealed positive patellar abrasion test and decreased flexion and extension of the knee joint.Because of the large population base and the increasing trend of aging in China,degenerative knee joint disease is particularly widespread.According to relevant studies,about 60%of knee osteoarthritis has degenerative changes of patellofemoral joint.Pain is the first and most important symptom of patellofemoral arthritis,and it is also the main factor for patients to see a doctor.Patellofemoral arthritis and knee osteoarthritis are often treated together in the course of clinical diagnosis and treatment,early onset of patellofemoral arthritis is often treated with rest and braking,or oral NSAIDs;in the middle stage,arthroplasty and arthroscopic surgery are the main methods;the treatment of severe patellofemoral joint degeneration is mainly arthroplasty these days,while the treatment of patella is mainly decompression.The good and the bad are intermingled the existing treatment,and there is the suspicion of over-treatment.The decrease of the pertinence of diagnosis and treatment also makes the clinical effect unsatisfactory,and patients suffered from knee pain and unnecessary economic and ideological burden indirectly.In the meantime,patients also affected the life of.inferior quality.The high incidence of patellofemoral arthritis and the important function of the knee joint determine the necessity of a more rigorous and effective treatment programs.At present,the application of traditional Chinese medicine technology in patellofemoral arthritis is quite common.Because of the different treatment schemes and follow-up procedures,the curative effect of this empirical therapy has its own merits,and the therapeutic mechanism of this empirical therapy is difficult to explain clearly.Therefore,how to deal with patellofemoral arthritis better in the early or mid-stage is particularly important.We had accumulated a wide range of clinical results in the treatment of degenerative diseases by Pi Zhen in our hospital in the early clinical research,The therapeutic effect of Pi Zhen on fascial diseases has also been recognized.The treatment of knee osteoarthritis by Pi Zhen in the past showed that the lysis could effectively reduce the anterior knee pain and improve knee joint activity,with definite effect.Based on this and drawing lessons from the theory of JinShuGu,in order to make the diagnosis and treatment of knee joint degeneration more rigorous and efficient,the scope of research is narrowed down to patellofemoral joint.We proposed an academic hypothesis that Pi Zhen lysis can effectively relieve pain and improve knee function in patellofemoral arthritis.By means of networked randomized controlled clinical study system,through the method of randomized controlled clinical study,to further improve the practices of t the early and middle stage patellofemoral arthritis pain treated by Pi Zhen,to evaluate the clinical effect and advantages of Pi Zhen for patellofemoral arthritis,and to analyze the advantages and characteristics of intra-articular and extra-articular treatment methods by comparing with intra-articular injection of sodium hyaluronate.In order to further clarify the mechanism of Pi Zhen lvsis,we studied the biomechanical changes of patellofemoral joint by finite element analysis,and proposed the hypothesis that the release of lateral patellofemoral retinaculum by beryllium needle can improve the stress set of patellofemoral joint.It was found that the release of lateral patellar retinaculum by Pi Zhen could reduce the local high pressure stress,reallocate the load and stress distrib ution of knee joint,and help to reduce the wear between cartilagesThe innovative performance of this study is that the thinking of diagnosis and treatment of patellofemoral arthritis has been changed from"treat the bone while bone disease" to "treat the bone desease through tendons" and "synchronize treat tendons and bones" under the guidance of the theory of "JinShuGu",and the biomechanical mechanism of Pi Zhen lysis has been studied for the first time by finite element analysis method,which provides new research methods and ideas for other invasive operations of traditional Chinese medicine in the treatment of tendons and bones diseases.The research of beryllium needle in the treatment of patellofemoral arthritis pain is conducive to improving the cure rate of patients,promoting the popularization and application of Pi Zhen in traditional Chinese medicine.The study of biomechanical mechanism will further increase the persuasion of diagnosis and treatment of traditional Chinese medicine,and provide scientific basis for clinical treatment.The development of this study caters to the trend of developing traditional Chinese medicine.The simplicity of medical operation and the reduction of cost also meet the requirements of medical reform.Therefore,this study will analyze the practical problems in clinical application from a prospective perspective,focusing on eliminating knee pain effectively and improving knee function in patients with patellofemoral arthritis.Thus,the treatment of patellofemoral arthritis will more standardized and efficient.1 Randomized controlled study of patellofemoral arthritis pain treated by Pi Zhen lysis1.1 Research objectiveGuided by the Chinese medical theory of "JinShuGu",combined with the pain characteristics of patellofemoral arthritis,through clinical randomized controlled study,to improve the standard of Pi Zhen Lysis in the treatment of patellofemoral arthritis pain,and to evaluate the clinical effect and advantages of Pi Zhen in the treatment of patellofemoral arthritis pain.Based on the results of treatment,the mechanism and clinical significance of the Pi Zhen in relieving pain of patellofemoral arthritis were discussed,which could provide clinical reference for the distinguishing TCM treatment of degenerative diseases of tendons and bones with Pi Zhen.1.2 Materials and MethodsThis study was a multi-center randomized clinical study.The cases were collected from Wangjing Hospital and the institute of orthopedics,Pinggu District Hospital of Traditional Chinese Medicine and Beijing Fengsheng Hospital.A total of 156 patellofemoral arthritis patients who met the criteria were randomly divided into experimental group and control group with 78 cases in each group.Pi Zhen lysis was used in experimental group and sodium hyaluronate joint puncture was used in control group.The design treatment and observation period was 5 weeks.The VAS score,tenderness index,knee joint activity and Lysholm knee joint score were recorded before treatment and after 3 times and 5 times treatments respectively.SPSS18.0 software was used to process data and compare the overall efficacy of the two groups.1.3 Research ResultsThere was no difference between the two groups in general information,such as age,sex,time of onset,body mass index,predisposing factor,tenderness and position of pressure pain(P>0.05).What’s more,there was no difference in first VAS score,knee activity and Lysholm knee joint score before treatment.Through clinical treatment and follow-up,the two groups of patellofemoral arthritis patients were effectively treated.The clinical evaluation indicators were as follows:(1)Comparison both the before and after treatment:The VAS score,tenderness index,knee motion and Lysholm knee score of the two groups were improved after 3 and 5 treatments compared with bfore.(2)Contrast of last clinical observation indexes:①The VAS score was 1.57±0.92 in the experimental group and 1.53±1.16 in the control group,P=0.194>0.05,there was no significant difference between the two groups.②The local tenderness test:the experimental group was 2.30±1.02;the control group was 2.10±1.18,P=0.00<0.05.It was considered that the local pain relief was more obvious in the experimental group.③The knee joint motion was 126.30±11.24 in the experimental group and 131.57±10.83 in the control group,P=0.00<0.05,the results showed that the knee joint motion of the control group improved better than experimental group.④The Lysholm knee score:the test group was 82.66±9.17 and the control group was 77.30±8.26.The Lysholm knee joint score of the test group was higher than that of the control group,P=0.00<0.05,the difference was statistically significant,it is considered that the clinical effect of the test group is better than the control.(3)Overall efficacy evaluation:After 5 weeks of treatment,the excellent and good rate of the experimental group was 84.62%and the total effective rate was 94.87%,the excellent and good rate of the control group was 69.23%,and the total effective rate was 92.31%.The total effective rate of the two groups was basically the same,but the excellent rate of the test group was higher than that of the control group.1.4 ConclusionsGuided by the TCM theory of“JinShuGu”,Pi Zhen lysis is effective in the treatment of patellofemoral arthritis in the early and middle stages.It can reduce the pain of patients and improve knee function effectively.Compared with joint puncture,Pi Zhen lysis can also reduce the cost of medical treatment significantly,and with fewer side effects.The treatment of Pi Zhen lysis has high application value and is worthy of clinical reference and application.2 Finite element analysis study of stress concentration in patellofemoral joint improving by releasing lateral patellar retaining belt with Pi Zhen.2.1 Reserch objectiveBased on the construction of three-dimensional finite element model of knee joint and its validation of effectiveness,to study the mechanism of Pi Zhen to improve stress concentration in patellofemoral joint via release lateral patellar retinaculum,and to explore and analyze the mechanism of Pi Zhen lysis in changing patellar trajectory and reducing patellofemoral joint pressure from the biomechanical aspect.It will provide biomechanical support for the diagnosis and treatment of patellofemoral joint diseases and open up new ideas for clinical application of knee joint.2.2 Research MethodsThe knee of a normal male(age 29,height 171 cm,weight 58 kg)was selected and the original image data were obtained by CT scanning.Starting with the construction of three-dimensional model of knee joint by using finite element software,the finite element model of knee joint with complete tendon and bone structures were established through several steps,such as geometric reconstruction,reverse engineering,meshing,material assignment and loading analysis.The validity of the finite element model and the scientificity of working condition loading are verified by literature.The loading condition was set as 500 N load on knee joint,and the average tensile stress of quadriceps femoris tendon was about 200 N.To simulate the release of lateral patellar retinaculum by Pi Zhen at 30 and 90 position of knee flexion in finite element model separately,and to compare the improvement of stress concentration of patellofemoral joint by Pi Zhen intervention under different knee flexion conditions.The reserch results will revealed the biomechanical mechanism of patellofemoral joint and the mechanism of Pi Zhen lysis.2.3 Reserch Results(1)Established a highly simulated finite element model of knee joint and verify its validity.In this study,14 independent tissue units were constructed based on anatomical characteristics,and 21 refined tissue units were constructed.The more perfect finite element model can more intuitively and accurately reflect the stability mechanism and locus of patellofemoral joint,and provide a good experimental platform for further analysis and calculation.The model was tested under the same loading conditions as previous literatures and found that the stress magnitude and change mechanism of the main bearing surface of the knee joint were consistent(the difference was between 1%and 13.5%).It was found that the stress changes were similar to those of other literatures,which proved the validity of the model.(2)clarified the biomechanical mechanism of Pi Zhen in improving stress concentration in patellofemoral jointLoading study under different working conditions shows that the stress magnitude of patellofemoral joint was as follows:knee flexion 90 degrees without intervention>knee flexion 90 degrees with intervention>knee flexion 30 degrees without intervention>knee flexion 30 degrees with intervention.The peak stress of patellofemoral joint and tibiofemoral joint decreased after Pi Zhen Lysis of patellofemoral lateral retinaculum compared with before intervention,respectively:(1)knee flexion at 30 degrees:patellar cartilage decreased by 0.498 MPa(9.06%),femoral trochlea decreased by 0.886 MPa(16.27%);knee flexion at 90 degrees:patellar cartilage decreased by 0.558 MPa(8.6%),femoral trochlea decreased by 0.607 MPa(9.94%).Combined with the equivalent force nephogram,it can be found that the stress peak value of patellar cartilage decreases immediately after the release of lateral retinaculum,especially in the lateral high reaction area.The stress of tibiofemoral joint is more widely distributed on the loading surface of tibial plateau and meniscus,and the stress peak value decreases with the expansion of the stress bearing surface.2.4 ConclusionsReleasing the lateral patellofemoral retinaculum with Pi Zhen can effectively alleviate the stress concentration of patellofemoral joint,improve the patellar motion track and redistribute the stress.At the same time,the joint stress more widely and evenly distributed on the articular surface,the peak stress in joint activity were reduced.Thus,the high stress wear of local articular cartilage caused by high pressure syndrome caused by stress concentration can be reduced. |
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