| Background:AS the most common bone and joint disease in clinic,Knee osteoarthritis has an impact on patients’ daily life and work in varying degrees.With the aggravation of the aging of the world population and the increase of overweight population,the incidence of knee osteoarthritis is increasing year by year.Knee osteoarthritis has attracted wide attention from all walks of life,especially in the medical field.In view of the complexity of the pathogenesis of KOA and the high degree of heterogeneity in the clinical process,it is very important to distinguish the clinical phenotype,especially in the early stage of the disease.More and more studies have applied particularly relevant outcome indicators according to the pathophysiological mechanism of KOA.Although the most specific treatment has not been found at present,there may be a relatively appropriate intervention according to different phenotypes and symptom tendencies of KOA,which is also a research hotspot in the world.More and more studies have applied particularly relevant outcome indicators according to the physiological and pathological mechanism and imaging findings of KOA.In KOA,Effusion-Synovitis represents an inflammatory phenotype,which is a concept derived from the MRI scoring system.Its volume change indicates recent inflammatory dynamics.Objective:Knee osteoarthritis was treated with massage(experimental group)and Votalin(control group).The main observation targets were the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and the volume of Effusion-Synovitis based on(MRI).To explore whether massage can affect the absorption and metabolism of Effusion-Synovitis in patients with knee osteoarthritis.(2)whether the severity of Effusion-Synovitis affects the therapeutic efficiency of massage.(3)whether the volume change of Effusion-Synovitis after treatment is related to the improvement of symptoms.Methods:In this randomized and parallel controlled trial,the patients were divided into massage group and Votalin group with the proportion of experimental group:control group=2:1,the experimental group was treated with massage twice a week for a total of 10 weeks,and the control group was treated with Votalin emulsion for a total of 10 weeks.Based on the semi-quantitative score of MRI Effusion-Synovitis,the subgroup models of knee osteoarthritis patients were established according to the severity of Effusion-Synovitis(grade 0 group,grade 1 group,grade 2 group,grade 3 group).The curative effect was evaluated by comparing the WOMAC score and Effusion-Synovitis volume before and after the two intervention methods.The correlation between the change of WOMAC score and the volume change of Effusion-Synovitis was analyzed by simple linear regression and generalized linear regression model.Results:1.Overall results of the experimental group and the control groupA total of 87 patients were included in this study,including 51 patients treated with massage and 36 patients treated with Votalin.There were significant changes in the total score of WOMAC before and after treatment in the manipulation group and Votalin group(P<0.001),and both of the two intervention methods were effective in the treatment of KOA.The change value of WOMAC total score in the manipulation group was higher,and the difference of score change was statistically significant(P<0.001),suggesting that manual therapy is more effective than Votalin treatment.The pain score,function score and stiffness score of the two intervention methods decreased significantly after treatment(P<0.001).The changes before and after treatment were statistically significant,indicating that the pain,stiffness symptoms and activity function were improved by the two intervention methods.There were significant differences in pain,stiffness and function scores between the two intervention methods(P<0.05),and the scores of each domain in the manipulation group were higher than those in the manipulation group,indicating that the improvement of pain,stiffness and activity function was more obvious in the manipulation group.The Effusion-Synovitis volume decreased after treatment in both groups(P<0.001),but there was no significant difference in Effusion-Synovitis volume between manipulation group and Votalin group(P>0.05).The semi-quantitative score of Effusion-Synovitis in both groups decreased after treatment,P<0.05,and the changes before and after treatment were statistically significant.There was no significant difference in semi-quantitative score of Effusion-Synovitis between manipulation group and Votalin group(P>0.05).It shows that the two intervention methods can promote the absorption and metabolism of Effusion-Synovitis,but generally speaking,manual therapy has no advantage in promoting the absorption and metabolism of Effusion-Synovitis.2.Results of subgroups of experimental group and control groupBased on the MRI Effusion-Synovitis grade,the patients were divided into grade 0 group(n=20),grade 1 group(n=27),grade 2 group(n=26),grade 3 group(n=14),The change value of WOMAC total score in grade 0 group,grade 2 group and grade 3 group was significantly higher than that in Votalin group(P<0.05).There was no significant difference in the total score of WOMAC between the two intervention methods in the grade 1 group.The results showed that manual therapy was more effective than Votalin in grade 0 group,grade 2 group and grade 3 group.The Effusion-Synovitis volume of grade 1 group,grade 2 group and grade 3 group decreased after treatment(P<0.01),and the changes before and after treatment were statistically significant,indicating that in KOA cases with mild,moderate and severe Effusion-Synovitis phenotype,manual therapy played a role in promoting Effusion-Synovitis absorption and metabolism.After treatment with Votalin,only the membrane exudation volume of grade 3 group decreased(P<0.01),and the change before and after treatment was statistically significant.It is suggested that in KOA cases with severe Effusion-Synovitis phenotype,Votalin treatment can significantly promote Effusion-Synovitis absorption and metabolism.The change of Effusion-Synovitis volume in grade 2 group and grade 3 group was significantly higher than that in Votalin group(P<0.05).There was no significant difference in Effusion-Synovitis volume between grade 0 group and grade 1 group(P>0.05).It is suggested that in KOA cases with moderate and severe Effusion-Synovitis phenotype,the effect of manual therapy on promoting Effusion-Synovitis absorption and metabolism is better than that of Votalin.3.Results of correlation analysisIn KOA cases with Effusion-Synovitis phenotype,there was a linear correlation between the change of Effusion-Synovitis volume and the change of WOMAC score.The total score change of WOAMC in grade 3 group was 0.6177*STV change-7.585,F=8.554.The change value of WOAMC total score in grade 2 group=0.6189*STV change+0.09116,F=33.93.The change value of WOAMC total score in grade 1 group=0.2401*STV change+2.762,F=22.91.There was no correlation in grade 0 group(R<0.3).The change of Effusion-Synovitis volume was correlated with the change of WOMAC subdomain score,the functional change β was 0.78(95%CI=0.51-1.05)(P<0.01).pain change β was 0.17(95%CI=0.04-0.29),stiff changeβ was 0.07(95%CI=0.00-0.15)The change rate of Effusion-Synovitis volume was correlated with pain and functional subdomain score,and the functional change β was 17.08(95%CI 12.61-21.56)(P<0.01).pain change β was 3.44(95%CI=1.14-5.74).Conclusion:1.Massage can effectively relieve the clinical symptoms of knee osteoarthritis and help Effusion-Synovitis absorption and metabolism in patients with knee osteoarthritis.2.For KOA cases with Effusion-Synovitis phenotype,the higher the grade of Effusion-Synovitis,the more obvious the effect of massage to promote Effusion-Synovitis absorption and metabolism.3.Compared with mild Effusion-Synovitis,massage has a great advantage in improving the symptoms of KOA patients with no,moderate or severe Effusion-Synovitis.4.The Effusion-Synovitis volume at the baseline stage can predict the benefit of the improvement of patients’activity function to a certain extent.5.In KOA patients with Effusion-Synovitis phenotype,there is a correlation between Effusion-Synovitis volume and WOMAC score,and Effusion-Synovitis volume is expected to become an objective indicator of short-term treatment benefits in patients with KOA.6.The change of Effusion-Synovitis volume or the rate of Effusion-Synovitis volume change can predict the benefit of symptoms in patients with KOA to a certain extent. |
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