| Osteoarthritis(OA)of the knee is a chronic joint disease characterized by degeneration,destruction and hyperosteogeny of articular cartilage.It is considered the most common disease in the world.Age,obesity,inflammation,trauma and genetic factors are associated with the occurrence of the disease,which is fundamental on the degeneration of knee joint and surrounding tissue,including peripheral muscle strength decline,ligament relaxation,bursitis,synovitis,cartilage and meniscus lesions.First,hotspot of current research is based on the degeneration of synovial and cartilage.The more generally accepted mechanism is the innate immune response(non-specific immune activation)of OA synovial inflammation.For example,our research show that there is a significant correlation between the synovial inflammation and the expression of TLRs?NF-?B.Another studies have shown that specific T cell mediated immunity also participate in the occurrence and development of knee OA,but there is no theoretical data from basic experiment support the viewpoint.Therefore,we put forward the following hypothesis:non-specific immune activation is the main mechanism of the knee OA,and specific immunity also play a subordinate role in it.They affects each other and regulates the pathogenesis and development of the knee OA.Based on this hypothesis,we have studied the expression of the co stimulatory molecules CD28 and CD14.Second,in clinical,the main pathological changes of the knee OA are the synovium of the knee joint and the degeneration of the meniscus.The external therapies of traditional Chinese medicine has many advantages.The external therapies of TCM is defined as the way of treating drugs on the body surface by hand or apparatus outside,including acupuncture,massage,acupotomy,external use of Chinese medicine and so on.We innovatively combined the two external therapies of TCM acupotomy guided by Musculoskeletal ultrasound combined with sonophoresis Tongluo Zhitong gel patch to expound its clinical efficacy for KOA,and further demonstrate the advantages of external therapy of TCM on KOA.Objective:1.The clinical and infratest methods are also used.Based on the combined application of needle knife guided by musculoskeletal ultrasound and sonophoresis Tongluo Zhitong gel patch treatment of knee OA,we mainly through pathological analysis the relationship between the knee osteoarthritis synovial lesions?meniscus lesions and clinical symptoms,to observe the clinical curative effect of the treatment.Based on the application of external therapy of traditional Chinese medicine(Tongluozhitong)as a means of intervention,and explore the pathogenesis of knee from immunology;2.The external therapy of TCM combined with ultrasound technology provides a new method for precise treatment of knee OA which would further inherit and develop the external therapy.Methods:Fundamental experiment research:1.Synovial cells of model knee OA rats were cultivated in vitro,and intervent in different concentrations of Tongluozhitong medicine,which were all high excited by LPS.The results compared with the control group of LPS.Flow cytometry were used to detect the synovial cell apoptosis and statistical analysis of the effect on synovial apoptosis of Tongluozhitong medicine;2.The human synovial cells were cultured in cell culture and intervent in different concentrations of Tongluozhitong medicine,which were all high excited by LPS.The results compared with the control group of LPS.Flow cytometry was used to observe the expression of CD28 and CD14 before and after the intervention.Clinical research:1.According to the knee OA intervention,the KOA patients were randomly divided into three groups.Group A(combined two external therapy):needle knife guided by musculoskeletal ultrasound and sonophoresis Tongluo Zhitong gel patch;Group B(single external therapy):sonophoresis Tongluo Zhitong gel patch;Group C(control group):joint puncture chitosan and NASIDs po group.The relationship of the pathological features of the knee OA?the Lysholm score and the VAS score were collected.2.Analysis the relationship between synovial lesions,meniscus lesions and joint effusion of the knee OA.Objective to analyze the correlation between the main pathological changes of knee OA,synovial lesions,meniscus lesions,joint effusion and Lysholm score and VAS score,and to explore the effect on knee OA symptoms.3.The clinical effects of three groups of A,B and C were analyzed,and the difference between them was compared.Results:Fundamental experiment research:1.The high concentration Tongluo Zhitong prescription group compared with the control group,P<0.05,the difference has statistical significance.Compared with the control group,the medium and low concentration groups were P=0.51>0.05,and the difference was not statistically significant.It shows that the high concentration Tongluo Zhitong prescription can promote the apoptosis of synovial cells.2.The expression of CD14 and CD28 were increased after the intervene of Tongluo Zhitong prescription and immune responses all had the concentration tolerance.Compared with the control group,the difference was statistically significant.Clinical research:1.Study on the correlation between the joint effusion quantity and meniscus lesions,through multiple regression analysis,the meniscus lesions develop as independent variables,the regression equation of y=0.195x+0.341,R=0.105,F=1.468,P=0.228,P<0.01 had significant difference.The results showed no obvious correlation between joint effusion quantity and meniscal lesions;Study on the correlation between synovial hyperplasia and meniscus lesions.Through multiple regression analysis,the meniscus lesions as variables to the regression equation:y=0.409x+0.06,R=0.372,F=21.155,P=0.000.The difference was statistically significant,and the results showed that the synovial hyperplasia had a low correlation with the meniscus disease.2.Before and after treatment in the three groups of Lysholm,VAS score and meniscus bulging distance were collected(A group 33 cases,30 cases in B group and C group were 36 cases,three cases of a total of 99 cases,if the treatment of meniscus bulge disappeared,numerical recorded as 0,a total of 198 groups before and after treatment respectively for party data).Single factor repeated measurement data analysis were used,P<0.01,the difference was statistically significant,and the results showed that Lysholm,VAS and bulging meniscus distance score had a correlation with each other.3.Before and after treatment in the three groups of Lysholm,VAS score and joint effusion volume(31 cases in A group,28 cases in B group and C group were 29 cases,three cases of a total of 88 cases,if the effusion disappeared after treatment.The score was recorded as 0.Before and after treatment,the total number was 176).Single factor repeated measurement data analysis were used,P<0.01,the difference was statistically significant,and the results showed that Lysholm,VAS and joint effusion(superior patellar pouch fluid)had a correlation with each other.4.The Lysholm score after 1 month between the three groups was compared.P>0.01,the difference has no statistically significant,which indicating that three groups of A,B and C can improve the quality of life of patients.The VAS score after 1 month between the three groups was compared.P<0.01,the difference has statistically significant,which indicating that the three groups were different in improving the pain of the patients.Group A and group B paired sample t test,Lysholm score,t=2.26,P=0.045>0.01,the difference has no statistically significant;VAS score,t?1.98,P=0.037>0.01,the difference has no statistically significant.Group A and group C paired sample t test,Lysholm score,t=5.57,P=0.008<0.01,the difference has statistically significant;VAS score,t=6.218,P=0.0025<0.01,the difference has statistically significant.B group and C row paired sample t test,Lysholm score,t=6.29,P=0.00<0.01,the difference has statistically significant;VAS score,t=3.42,P=0.0015<0.01,the difference has statistically significant.Conclusion:1.Tongluo Zhitong recipe can promote the apoptosis of synovial cells in model knee OA rats.2.CD14 and CD28 signals were activated after the application of Tongluo Zhitong prescription in human synovial culture cells,which indicating that CD14 and CD28 were involved in the immune response of A,and T cell mediated specific immune response may be involved in the pathogenesis and progression of KOA.3.The curative effect of external therapy of TCM on knee OA is exact.Combined with two external therapies of TCM,acupotomy guided by musculoskeletal ultrasound combined with sonophoresis Tongluo Zhitong gel patch,the effect of which is affirmative and recommended widely.4.The main pathological features of knee OA,such as synovitis and meniscus lesions,are correlated with VAS score and Lysholm score.The external therapy of TCM on the synovitis and meniscus diseases can improve the clinical symptoms of the patients.5.Acupotomy guided by musculoskeletal ultrasound has the advantages of high safety and high improvement than the traditional acupotomy.it is innovative. |
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