Evaluation Of Clinical Efficacy Of Oral And External Preparations In The Treatment Of Knee Osteoarthritis Based On Musculoskeletal Ultrasound

Objective: To investigate the clinical effects of Qingre Chushi Zhitong liquid and Qingre Zhufeng ointment,Yishen Jiangu pill and Qiangjin Yishen Jiangu ointment on rheumatic heat Bi type and liver kidney deficiency type of knee osteoarthritis based on musculoskeletal ultrasound,so as to provide a more effective treatment for early and middle stage of knee osteoarthritis.Methods: Patients with knee osteoarthritis who were treated in the First Affiliated Hospital of Guangxi University of traditional Chinese medicine from October 2018 to August 2020 were randomly selected,and the TCM syndrome differentiation was divided into rheumatic heat Bi type or liver and kidney deficiency type,with 40 patients in each group,The control group was treated with sodium hyaluronate injection and paracetamol tablets.Before treatment,all patients had knee anteroposterior and lateral radiographs(standing position)and 45 ° Axial radiographs of patella were taken to confirm the diagnosis;Before and 3 months after the treatment,the ultrasound examination of knee joint muscle and bone was performed to observe the amount of effusion in the joint cavity,the thickness of synovium and the degree of cartilage damage,and to evaluate the effect of drugs on knee osteoarthritis;WOMAC score and TCM symptom score were performed before treatment,5 weeks after treatment and 3 months after treatment;Blood routine,urine routine,fasting blood glucose,liver function(ALT and AST),renal function examination and electrocardiogram(15 leads)were performed before and 3 months after treatment to evaluate the safety of the drug.Results: 78 patients completed the corresponding treatment,and there was no significant difference in WOMAC score and TCM symptom score among the four groups before treatment(P > 0.05);WOMAC score and TCM symptom score of four groups were significantly lower than those before treatment(P <0.05);The WOMAC score and TCM symptom score of the experimental group were lower than those of the control group.The WOMAC score and TCM symptom score of the experimental group were lower than those of the control group.The difference was statistically significant(P<0.05).There were significant differences in the amount of joint effusion,the thickness of synovium and the injury grade of articular cartilage between the two groups before treatment(P<0.05).Three months after the end of treatment,the amount of effusion and synovial thickness of the knee joint in the four groups were significantly decreased compared with those before treatment(P<0.05),but there was no significant difference in articular cartilage injury grade(P>0.05).Before treatment,WOMAC score of rheumatic heat arthralgia type was correlated with the amount of joint effusion and synovial thickness(P<0.05),but not with the cartilage injury grade;At 3 months after the treatment,WOMAC score of rheumatic fever type was correlated with the amount of effusion,synovial thickness and cartilage injury grade(P<0.05);Before and 3 months after treatment,WOMAC score of liver and kidney deficiency type was correlated with the amount of joint cavity effusion,synovial thickness and cartilage injury grade(P<0.05).The blood routine,urine routine,fasting blood glucose,liver function(ALT and AST),renal function examination and electrocardiogram(lead 15)of all patients before and 3 months after treatment were normal.Conclusion:(1)Qingre Chushi Zhitong liquid and Qingre Zhufeng ointment,Yishen Jiangu pill and Qiangjin Yishen Jiangu ointment are effective in treating knee osteoarthritis of rheumatism heat Bi type and liver kidney deficiency type,which are better than sodium hyaluronate injection and acetaminophen tablets;(2)There are differences in musculoskeletal ultrasound manifestations between rheumatic heat arthralgia type and liver kidney deficiency type of knee osteoarthritis,which can provide certain objective basis for TCM syndrome differentiation of knee osteoarthritis(rheumatic heat arthralgia type and liver kidney deficiency type);(3)There are differences in the changes of musculoskeletal ultrasound before and after treatment between rheumatic heat arthralgia type and liver kidney deficiency type of knee osteoarthritis,and there is correlation between the changes of musculoskeletal ultrasound and WOMAC score,which can provide certain objective indicators for curative effect observation.