| ObjectiveKnee osteoarthritis is common in clinic. With the aggravation of population ageing, the morbidity of knee osteoarthritis increases gradually year by year. It will result in malformation or disability if it is improper treated or delayed intervened. So it will bring the most exquisite torment and worse life quality, even shorter lifetime. At present, although there are a lot of choice for treating knee osteoarthritis, their deficiencies limit the application. To seek a kind of treatment which is effective, with little side effects and suitable for HongKong, is still the research hotspot and difficult. The aim of our research is that through the evaluation of Tuina therapy, medium frequency impulsed electrotherapy and standardized function exercise, we will get the exact clinical effect of Tuina in treatment of knee osteoarthritis. Furthermore, we will supply the objective clinical evidence to demonstrate the effectiveness of Tuina in treatment of kneeosteoarthritis.Material and methods60 cases which is consistent with the inclusion and exclusion criteria are randomly divided into 2 groups, basic treatment group (control group) and Tuina therapy group (treatment group). Standardized function exercise and medium frequency impulsed electrotherapy (30 minutes once daily for 14 days totally) were applied in control group, and additional Tuina therapy on specific acupoints in treatment group (25 minutes once daily for 14 days totally). Objective quantitative evaluations contain matrix metalloproteinase-3 (MMP-3), tissue inhibitor of metalloproteinase-1 (TIMP-1) and tumornecrosis factor-α (TNF-α) in synovial fluid. Correspondingly, subjective qualitative evaluations contain the swelling score, tenderness score, limited motion score and Lysholm knee function score. The evaluation time points are 1 day before treatment,1 day,3 days,7days and 14 days after treatment. The data was analyzed by SPSS 17.0 and P<0.05 was defined as the significant difference.Result1.DemographicsTreatment and evaluations were completed in all patients. There was no lost. The two groups were kept identical in age, gender, affected side, and disease course (P>0.05), indicating that the two groups were comparable before the treatment.2 MMP-32.1 Comparison between groupsThere were no significant difference between the two groups in MMP-3 at pre-treatment,1 day and 3 days after treatment (P>0.05). However, there were significant differences between the two groups in MMP-3 at 7 day and 14 days after treatment (P<0.05).2.2 Comparison in one groupThe MMP-3 content was significantly elevated in the control group at 1 day and 3 days after treatment compared with pre-treatment (1 day after treatment VS pre-treatment, t=-6.972, P=0.000; 3 day after treatment VS pre-treatment, Z=-1.848, P=0.045). The MMP-3 content return to the pre-treatment level at 7 days after treatment (7 day after treatment VS pre-treatment, t=-0.025, P=0.980). The MMP-3 content was significantly decreased in the control group at 14 days after treatment compared with pre-treatment (14 day after treatment VS pre-treatment, t=8.667, P=0.000). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, Z=-4.450, P=0.000; 3 day after treatment VS pre-treatment, Z=-4.450, P=0.000; 7 day after treatment VS pre-treatment, Z=-2.232, P=0.026; 14 day after treatment VS pre-treatment, t=11.861, P=0.000).3 TIMP-13.1 Comparison between groupsThere were no significant difference between the two groups in TIMP-1 at pre-treatment,1 day and 3 days after treatment (P>0.05). However, there were significant differences between the two groups in TIMP-1 at 7 day and 14 days after treatment (P<0.05).3.2 Comparison in one groupThe TIMP-1 content was significantly elevated in the control group at1 day,3 days and 7 days after treatment compared with pre-treatment (1 day after treatment VS pre-treatment, t=-6.862, P=0.000; 3 day after treatment VS pre-treatment, Z=-3.341, P=0.001; 7 day after treatment VS pre-treatment, t=-2.195, P=0.034). The TIMP-1 content was significantly decreased in the control group at 14 days after treatment compared with pre-treatment (14 day after treatment VS pre-treatment, t=2.217, P=0.031). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, t=-8.414, P=0.000; 3 day after treatment VS pre-treatment, Z=-3.120, P=0.002; 7 day after treatment VS pre-treatment, t=2.159, P=0.035; 14 day after treatment VS pre-treatment, Z=-3.740, P=0.000).4 TNF-α4.1 Comparison between groupsThere were no significant difference between the two groups in TNF-α at pre-treatment,1 day and 3 days after treatment (P>0.05). However, there were significant differences between the two groups in TNF-α at 7 day and 14 days after treatment (P<0.05).4.2 Comparison in one groupThe TNF-α content was significantly elevated in the control group at 1 day after treatment compared with pre-treatment (1 day after treatment VS pre-treatment, t=-5.500, P=0.000). The TNF-α content return to the pre-treatment level at 3 days after treatment (3 day after treatment VS pre-treatment, t=0.188, P=0.852). The TNF-α content was significantly decreased in the control group at 7days,14 days after treatment compared with pre-treatment (7 days after treatment VS pre-treatment, t=2.247, P=0.028; 14 day after treatment VS pre-treatment, t=5.731, P=0.000). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, t=-8.149, P=0.000; 3 days after treatment VS pre-treatment, Z=-0.163, P=0.871; 7 days after treatment VS pre-treatment, t=6.756, P=0.000; 14 days after treatment VS pre-treatment, t=11.429, P=0.000).5 Swelling score5.1 Comparison between groupsThere were no significant difference between the two groups in Swelling score at pre-treatment and 1 day after treatment (P>0.05). However, there were significant differences between the two groups in Swelling score at 3 days,7 days and 14 days after treatment (P<0.05). 5.2 Comparison in one groupCompared with pre-treatment, there were no significant difference at 1 day and 3 days after treatment in the control group (1 day after treatment VS pre-treatment, Z=-0.563, P=0.573; 3 days after treatment VS pre-treatment, Z=-0.683, P=0.495). The Swelling score was significantly decreased in the control group at 7days and 14 days after treatment compared with pre-treatment (7 days after treatment VS pre-treatment, Z=-1.977, P=0.048; 14 day after treatment VS pre-treatment, Z=-2.984, P=0.003). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, Z=-0.725, P=0.468; 3 days after treatment VS pre-treatment, Z=-1.816, P=0.069; 7 days after treatment VS pre-treatment, Z=-3.871, P=0.000; 14 days after treatment VS pre-treatment, Z=-4.506, P=0.000).6 Tenderness score6.1 Comparison between groupsThere were no significant difference between the two groups in Swelling score at all time points (P>0.05).6.2 Comparison in one groupCompared with pre-treatment, there were no significant difference at 1 day after treatment in the control group (1 day after treatment VS pre-treatment, Z=-0.394, P=0.694). The tenderness score was significantly decreased in the control group at 3 days,7days and 14 days after treatment compared with pre-treatment (3 days after treatment VS pre-treatment, Z=-2.279, P=0.023; 7 days after treatment VS pre-treatment, Z=-2.035, P=0.042; 14 day after treatment VS pre-treatment, Z=-2.892, P=0.004). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, Z=-1.670, P=0.095; 3 days after treatment VS pre-treatment, Z=-3.273, P=0.001; 7 days after treatment VS pre-treatment, Z=-3.219, P=0.001; 14 days after treatment VS pre-treatment, Z=-3.750, P=0.000).7 Limited motion score7.1 Comparison between groupsThere were no significant differences between the two groups in Swelling score at pre-treatment,1 day,3 days and 7 days after treatment (P>0.05). However, there was significant difference between the two groups in Limited motion score at 14 days after treatment (P<0.05).7.2 Comparison in one groupCompared with pre-treatment, there were no significant differences at 1 day and 3 days after treatment in the control group (1 day after treatment VS pre-treatment, Z=-0.631, P=0.528; 3 days after treatment VS pre-treatment, Z=-0.918, P=0.358). The Limited motion score was significantly decreased in the control group at 7days and 14 days after treatment compared with pre-treatment (7 days after treatment VS pre-treatment, Z=-2.197, P=0.028; 14 day after treatment VS pre-treatment, Z=-3.375, P=0.001). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, Z=-0.622, P=0.534; 3 days after treatment VS pre-treatment, Z=-0.654, P=0.513; 7 days after treatment VS pre-treatment, Z=-2.897, P=0.004; 14 days after treatment VS pre-treatment, Z=-3.267, P=0.001).8 Lysholm knee function score8.1 Comparison between groupsThere were no significant differences between the two groups in Lysholm score at pre-treatment and 1 day after treatment (P>0.05). However, there was significant difference between the two groups in Lysholm score at 3 days,7 days and 14 days after treatment (P<0.05).8.2 Comparison in one groupCompared with pre-treatment, there was no significant difference at 1 day after treatment in the control group (1 day after treatment VS pre-treatment, Z=-l.267, P=0.205). The Lysholm score was significantly improved in the control group at 3 days,7days and 14 days after treatment compared with pre-treatment (3 days after treatment VS pre-treatment, Z=-2.702, P=0.010; 7 days after treatment VS pre-treatment, Z=-5.978, P=0.000; 14 day after treatment VS pre-treatment, Z=-9.151, P=0.000). The results in the treatment group was similar to the control group (1 day after treatment VS pre-treatment, Z=-0.483, P=0.629; 3 days after treatment VS pre-treatment, Z=-5.670, P=0.000; 7 days after treatment VS pre-treatment, Z=-6.343, P=0.000; 14 days after treatment VS pre-treatment, Z=-6.483, P=0.000).ConclusionAs a characteristic Chinese treatment, Tuina therapy is a effective and safe choice for knee osteoarthritis. It can promoting qi circulation to relieve pain, promoting blood circulation to remove meridian obstruction, supply nutrition to arthrosis and cause the muscles and joints to relax. Accompany with basic treatment, Tuina therapy is proven to be highly effective in treatment of knee osteoarthritis. However, the advantage may be definite after a long time continuous therapy. |
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