Clinical Study On The Treatment Of Knee Osteoarthritis And Its Mechanism

Backgroud:Knee Osteoarthritis(KOA), which is known as degenerative osteoarthr-itis of the knee, is a common disease troubled by the elderly. It has many clinical manifestations such as joint pain, tenderness, stiffness, joint swelling,limited mobility and joint deformities. As the age increasing, the incidence of osteoarthritis increases, so more and more scholars focus on KOA’s research. Acupotomy therapy for KOA had been accepted by more and more people for its simple, convenient, efficient, inexpensive advantages etc. Acupotomology considers that the pain of KOA is close to the extra-articular soft tissue lesions, which are mainly for soft tissue lesions around the knee bursitis,adhesions ligament(tendon) and bone junction,scar contracture.fat pad degeneration Therefore the release with acupotomy on articular soft tissue to improve soft tissue lesions, relieve pain is very important. Meanwhile, improved soft tissue lesions also help improve knee function, especially on ligaments and tendons. Release can improve the high tension of these organizations. It’s of great significance for correcting the abnormalpower cord of the knee and reducing the intra-articular pressure. From the long-term perspective, the lines of force to improve intra-articular pressure decreasing can help the regenera-tion of articular cartilage and joint space significantly. Acupotomy therapy for KOA, has a direct and indirect effects, the former is the release of soft tissue, the later is contributed to the power lines correction and articular cartilage regeneration.Objective:Acupotomy therapy for KOA, mainly focusing on soft tissue around the knee, restoring mechanical balance,then to get therapeutic purposes.This article introduced the mentor’s clinical experience of the treatment for KOA in the early stage and observed the the treatment with acupotomy for the in juried rat’s medial collateral ligament in the experimental view of the local tissue morphology, then to verify the principle of acupotomy therapy for KOA is based on the treatment for the chronic soft tissue injury.Methods:Clinical part:To introduce the mentor’s clinical thinking and operating experience of the treatment for KOA,which is based on previous clinic cases and anatomical studies. For example,the common chronic soft tissue lesions of the knee using acupotomy therapy, patella displacement using acupotomy treatment and knee joint cavity puncture.Experiment part:Fifteen healthy male SD rats were randomly divided into normal group(n=3).model group(n=6).knife group(n=3),the hormone group (n=3). Surgi-cally transected the bilateral medial collateral ligament modeling (6 MCLs)at tibial plateau level in both hind limbs. After four weeks,each group receive treatments respectively. One week after treatment, All rats were sacrificed for HE staining, Picric acid-Sirius red staining, Smad3 immunohistochemical staining by observed in light microscopy. Finally analysis the statistical date and make the concluding.Results:Clinical part:Acupotomy treatment can quickly relieve pain and other symptoms of the knee, as well as improve knee motion and so on. The clinical efficacy is satisfactory.Experimental part:1 General observation:Normal ligament was white, wispy smooth, clearly distinguished with the surrounding tissue. The model group,acupotomy group, hormone group in the form of cross-sectional portion scar healing, translucent, together with the surrounding muscle tissue adhesion. The model,acupotomy and hormone group were not significantly different.2 HE staining:Normal ligament’s collagen fibers were relatively dense, neat, parallel bundles and a few ligament cells between the fibers. The model group ligaments’s collagen fibers were loose, disordered,associated with edema, fibroblasts, inflammatory cells, endothelial cells, microvascular hyperplasia and erythrocyte aggregation. The acupotomy group’s collagen fibers were disordered with fibroblasts, inflammatory cells, endothelial cells, microvascular hyperplasia and erythrocyte aggregation, but few edema and loose, more compact arrangement. The hormone group had no significant difference compared with the acupotomy group.3 Picric Sirius red staining:3.1 Each group of collagen under normal light showed red or purple,The model group, acupotomy group, hormone group were disordered. The model group, acupotomy group, hormone group compared with the normal group, the total collagen increased significantly (P<0.01,P<0.01,P<0.01).The acupotomy group and hormone group compared with the model group were significant reduce (P<0.01,P<0.01),the hormone group had no significant difference with the acupotomy group (P>0.05).3.2 Ⅰ、Ⅲ collagen in polarized lightUnder polarized light the normal group was observed mostly brown type Ⅰ collagen, a very small amount of type Ⅲ collagen, arranged in neat rows; The model group, acupotomy group, hormone group were mixed with disorganized brown type Ⅰ collagen and green type Ⅲ collagen.The model group’s Ⅰ collagen and Ⅲ collagen compared with the normal group were significantly increased (P<0.01, P<0.01); The acupotomy group’s type Ⅰ collagen and type Ⅲ collagen compared with the normal group were significantly increased (P<0.05,P<0.01). The hormone group’s type Ⅰ collagen reduced and type Ⅲ collagen increased significantly compared with the normal group (P<0.05,P<0.01).The acupotomy group’s type Ⅰ collagen and type Ⅲ collagen had no significant difference with the model group (P>0.05,P>0.05). The hormone group’s type Ⅰ collagen compared with the model group was reduce significantly(P<0.05)and Ⅲ collagen was no significant difference (P>0.05). The hormone group’s Ⅰ collagen and Ⅲ type collagen had no significant difference compared with the acupotomy group (P>0.05,P>0.05).4 Smad3 immunohistochemical stainingThe normal group’s cytoplasm were broad yellow. The model group,acupotomy group and hormone group’s fibroblast cytoplasm were brown or brown lumps.The model group and acupotomy group’s Smad3 compared with the normal group were significantly increased (P<0.01,P<0.01,P<0.01).while compared with the model group were statistically significant reduction(P<0.01,P<0.01). The hormone group had no significant difference compared with acupotomy group(P>0.05)Conclusion:1 Acupotomy treatment for KOA can restore the mechanical balance of knee through releasing soft tissue,then to achieve the therapeutic purposes.2 Acupotomy treatment can release the ligament damage and scar adhesion, improving local microcirculation,accelerating metabolism,reducing edema, reducing inflammatory cell infiltration,inhibit microvascular proliferation, improving the the disordered collagen of injuried ligament becoming more disciplinary and dense during remodeling phase.3 Acupotomy treatment loosen the remodeling phase ligament damage and scar adhesion, then reduce the total collagen content,probably by reducing the expression of Smad3.