| Objective:1.To verify the effectiveness of acupoint combined with sitting knee adjustment method in the treatment of knee osteoarthritis pain and improvement of joint function through clinical efficacy study;2.Through the pathological and biomechanical detection of the knee osteoarthritis cartilage,and the synovial fluid mass spectrometry analysis of the joint,the mechanism of action of acupoints combined with sitting and adjusting the knee on the knee osteoarthritis cartilage and the possible related inflammatory pathways were studied,so as to provide a theoretical basis for the mechanism of massage treatment of knee osteoarthritis.Methods:1.A randomized,controlled,single-blind clinical superior efficacy trial was conducted to evaluate the efficacy of point-point combined with sitting knee adjustment in the treatment of knee osteoarthritis pain and improvement of joint function.91 patients were randomly divided into manipulation treatment group and control group,and corresponding intervention measures were given.WOMAC score was the primary outcome after 4 weeks of treatment.Secondary outcome measures were tenderness threshold,VAS score at rest,VAS score during exercise,HADS score,and total effective rate.At the same time,the scores of adverse reaction indexes in 2 groups were recorded.2.20 cases to be prepared for the artificial knee joint replacement patients were randomly divided into treatment group and control group,each group of 10 cases,in the treatment of knee arthroplasty after 4 weeks,to observe the changes in cartilage damage degree,cartilage proteoglycan matrix around the glycolysis degree,change the subchondral bone and cartilage inflammation factors detection.3.20 patients prepared for artificial knee replacement were randomly divided into manual treatment group and control group,with 10 patients in each group.After 4weeks of treatment,artificial knee replacement was performed.Bone and cartilage tissue were collected from the weight-bearing joint surface during the operation,and the stress and deformation of cartilage were observed by biomechanical testing.4.20 patients with knee osteoarthritis were randomly divided into treatment group and control group,in addition to choose 3 cases of knee joint synovitis of young patients,a total of 23 cases,4 weeks after treatment,return joint synovial fluid,using mass spectrometry techniques,differences exist in the screening of synovial fluid metabolism of substances,and through KEGG network,found that may be related to metabolic pathways,and its correlation with the onset of osteoarthritis.Results:1.91 subjects were included in the randomized,single-blind,controlled clinical efficacy trial.WOMAC score of the manipulation group after 4 weeks of intervention was higher than that of the control group,with statistical difference.The tenderness threshold of the two groups was significantly higher than that before treatment,and the treatment group was better than the control group.VAS score of the two groups was significantly lower than that before treatment,and the treatment group was better than the control group.HADS scores in both groups decreased significantly after treatment and before treatment,and the improvement in the treatment group was better than that in the control group.The total effective rate was 93.18% in the treatment group and 81.40% in the control group,and there was a statistical difference between the two groups.Safety evaluation There was no statistically significant difference in overall adverse reactions between the two groups.2.Manipulative intervention in knee osteoarthritis,pathological examination showed that the number of chondrocytes and chondrocyte regeneration in the treatment group was not statistically different from that in the control group(P>0.05),while there were differences in other detection indicators(P<0.05).The degree of cartilage injury in the treatment group was lower than that in the control group.The degradation of matrix proteoglycan in the treatment group was less than that in the control group(P<0.05).The changes of subchondral bone tissue in the treatment group were less than those in the control group,and the degree of cartilage injury was less.There was no difference in IL-1 between the two groups(P>0.05),but there was difference in TNF-α and COX-2 between the treatment group and control group(P<0.05).3.After the biomechanical test of cartilage,it was found that the elastic modulus of the treatment group was smaller than that of the control group,and the surface cartilage elasticity was better,while the control group had a higher degree of degeneration,showing a decrease in elasticity and an increase in brittleness,and the compressive stress on fracture was correspondingly reduced.4.The results of mass spectrometry showed that there were significant differences among monoethylglycoyldimethylaniline,trimethylamine and piogate hexanoic acid.The expressions of arginine/proline metabolism pathway,methionine/cysteine metabolism pathway,pyrimidine metabolism pathway and primary bile acid biosynthesis pathway were significantly up-regulated,and the related metabolic pathway was IL-17.Conclusion:1.The combination of acupoint pressing and knee-adjusting method with sitting position in the treatment of knee osteoarthritis has better clinical effect than oral Celecoxib,which is a therapeutic method of massage with definite effect.2.The treatment of knee osteoarthritis by acupoint acupoints combined with sitting and adjusting the knee can improve the degeneration of cartilage,extraconchondral matrix and subchondral bone,and increase the anti-stress ability and anti-fracture ability of cartilage.The significant down-regulation of the metabolism pathway of IL-17 is one of the possible mechanisms of improving the degeneration of cartilage by synovial fluid mass spectrometry analysis. |
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