| Objective: To observe the clinical effect of acupotomy and ozone injection combined with hyperextension,hyperflexion and traction manipulation on knee osteoarthritis,and to observe the change of elastic modulus of soft tissue around the knee of KOA patients before and after treatment under real-time shear wave,to explore the effect of hyperextension,hyperflexion and traction manipulation on the elasticity of soft tissue around the knee,and to provide a possible objective basis for the manipulation treatment of KOA.Methods: From January 2020 to January 2021,a total of 60 patients with knee osteoarthritis were admitted to the Orthopedics Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese medicine,which met the diagnostic,inclusion and exclusion criteria of Chinese and Western medicine.In the observation group,30 cases were randomly divided into the observation group and the control group.On the basis of physical therapy,the observation group was treated with acupotomy and ozone joint cavity injection combined with hyperextension,hyperflexion and traction manipulation,while the control group was treated with functional exercise,using acupotomy and ozone joint cavity injection,at the same time with functional exercise.VAS scores and Womac index were recorded before treatment,before discharge(1 day before discharge),and 1 month after discharge.Real-time shear wave elastography was used to evaluate the elasticity of soft tissue around the knee joint at the above time points.All the statistical data were analyzed with SPSS21.0 software,and P < 0.05 was statistically significant.Results: A total of 57 patients completed treatment and follow-up,the treatment group completed 29 cases,the control group completed 28 cases,a total of 3 patients fell off,according to the treatment of excluded cases.1.There were no significant differences in sex,age,course of disease,BMI,Vas score before treatment,Womac index of osteoarthritis and elasticity of soft tissue around knee between the observation group and the control group,it has the same comparability(P > 0.05).2.Clinical value of VAS,Womac index of osteoarthritis and elastic modulus of soft tissue around knee:(1)There was significant difference between the two groups(p < 0.05).The VAS scores of the two groups were significantly different(p < 0.05).The VAS scores of the observation group were significantly lower than that of the control group.(2)There was significant difference in Womac index between the two groups(p < 0.05),and the difference between the two groups was significant(p < 0.05).But the interaction between time point and group was not significant(P > 0.05).(3)The modulus of elasticity of rectus femoris,medial femoris,lateral femoris and patellar tendon at different time points were significantly different(p < 0.05).The modulus of elasticity of rectus femoris,medial thigh muscle,lateral thigh muscle and patellar tendon of the two groups were statistically significant(p < 0.05);the modulus of elasticity of rectus femoris and medial thigh muscle of the two groups were statistically significant(p < 0.05);the modulus of elasticity of lateral thigh muscle and tendon of the two groups were not statistically significant(p > 0.05);the modulus of Medial collateral ligament and lateral collateral ligament of the two groups were not statistically significant(p > 0.05).3.The relationship between the changes of elastic modulus of soft tissue around the knee and the changes of VAS score and Womac index before and after treatment: there was a positive correlation between the changes of elastic modulus of rectus femoris and Womac index before and after treatment(ρ = 0.264 and p < 0.05);there was a positive correlation between the changes of elastic modulus of medial femoris and Womac index before and after treatment(ρ= 0.283 and P < 0.05).4.Evaluation of curative effect: after treatment,8 cases were controlled,14 cases were effective,4 cases were effective,3 cases were ineffective,the total effective rate was 89.66% in the observation group;5 cases were controlled,5 cases were effective,13 cases were effective,5 cases were ineffective,the total effective rate was 82.14%in the control group,the difference was statistically significant(p < 0.05).Conclusion: 1.Acupotomy and ozone injection combined with hyperextension,hyperflexion and traction manipulation in the treatment of knee osteoarthritis under the guidance of the concept of “yi tong wei shu,jin gu bing zhong”,the curative effect is obvious,safe and reliable,and worthy of clinical application.2.Hyperextension,hyperflexion and traction manipulation on KOA can relieve pain and improve function.It can relieve stress concentration of soft tissue around knee by reducing the elasticity of soft tissue around knee,especially the rectus femoris and medial femoris. |
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