Study On Arthroscopic Knee Osteoarthritis Manifestation And Relativity With TCM Syndrome Type, Cytokines And TCM Intervention

ObjectiveKnee osteoarthritis is one of common diseases for the elderly and its prevention and treatment is quite difficult in domestic and international medical community. By studying pathological manifestation of knee osteoarthritis under arthroscope and its correlation with TCM syndrome types and IL-6&TNF-α level in serum, this thesis firstly aims to provide an objective basis for clinical study of TCM syndrome types by exploring interrelationship of arthroscopic knee osteoarthritis between pathology and syndrome, and discuss pathological changes of various syndromes on knee osteoarthritis structure under arthroscope. The second aim is to explore the relationship between pathological changes on knee osteoarthritis structure under arthroscope and IL-6&TNF-α in serum, and discuss the role of these two cytokines during the development of this disease as well as reflect reliability of the pathological changes on disease structure. Meanwhile, combine arthroscopic knee surgery with TCM Juanbi Jianxi as treatment and observe efficacy score changes. Then explore the effectiveness of treating disease by the combination of arthroscopic knee surgery with TCM to provide future clinical reference.MethodThe first step is selecting patients with knee osteoarthritis and analyzing their syndrome types.80qualified patients are chosen to meet research criteria. The second step is detecting the level of TNF-α and IL-6in serum by chemiluminescence method before surgery. The third step is using arthroscopic surgery on patients and recording pathology of knee osteoarthritis structure under arthroscope of each type. The fourth step is randomly dividing patients into treatment group and control group. Treatment group take TCM Juanbi Jianxi and do functional exercise, but control group purely do functional exercise. Evaluate the efficacy of two groups according to knee function efficacy score. Finally, collect and analyze data to draw a conclusion.Result1. Research of arthroscopic pathology and syndrome typesCartilage damage of patients with qi stagnation and blood stasis is generally more severe than others and the difference is statistically significant (P=0.004<0.05), whereas other three types have no statistical difference after comparison (P>0.05).Synovial hyperplasia of patients with spleen and kidney yang deficiency is generally more severe than others and the difference is statistically significant (P<0.05), whereas other three types have no statistical difference after comparison (P>0.05).Hyperosteogeny of patients with wind-cold-dampness arthralgia is generally less severe than others and the difference is statistically significant (P<0.05), whereas other three types have no statistical difference after comparison (P>0.05).Patients with qi stagnation and blood stasis and spleen and kidney yang deficiency are basically the same on effusion of knee joint. The difference is not statistically significant (P=0.114>0.05). Patients with qi stagnation and blood stasis are more severe than the ones with liver and kidney yin deficiency and wind-cold-dampness arthralgia on joint effusion. The difference is statistically significant (P<0.05). Patients with spleen and kidney yang deficiency are more severe than the ones with liver and kidney yin deficiency and wind-cold-dampness arthralgia on joint effusion. The difference is statistically significant (P<0.05).In terms of meniscus damage comparison, the difference of various types is not statistically significant (P=0.979>0.05). In terms of joint mouse, patients of various types are essentially the same and the difference is not statistically significant (P=0.507>0.05).2. Research on arthroscopic pathology and cytokinesThe relationship between cartilage damage Outerbridge grade and IL-6&TNF-α level:IL-6level in serum of KOA patients with grade Ⅲ and IVis higher than the ones with grade I and Ⅱ and the difference is statistically significant (P<0.05);TNF-α level in serum of KOA patients with grade Ⅲ is higher than the ones with grade I and the difference is statistically significant (P=0.002<0.05). TNF-α level in serum of KOA patients with grade IV is higher than the ones with grade I and the difference is statistical significant (P=0.01<0.05).Relationship between the degree of synovial proliferation and IL-6&TNF-a level:IL-6level in serum of KOA patients with grade I is lower than the ones with grade II and Ⅲ and the difference is statistically significant (P <0.05).TNF-α level in serum of KOA patients with grade II is higher than the ones with grade I and the difference is statistically significant (P=0.001<0.05). TNF-α level in serum of KOA patients with grade Ⅲ is higher than the ones with grade I and the difference is statistically significant (P=0.048<0.05).Relationship between meniscus injury grade and the level of IL-6&TNF-a: comparison of measured value level between different classifications of IL-6show no statistical significance (P=0.134>0.05). Measured value of different TNF-α classifications is not the same and the difference shows a statistical significance (P=0.047<0.05). TNF-αlevel in serum of KOA patients with grade I is lower than the ones with grade Hand Ⅲ and the difference is statistically significant (P<0.05).Relativity of other arthroscopic pathologic manifestations (joint mouse, joint effusion, and hyperosteogeny) with level of IL-6&TNF-α:the comparison of joint mouse, joint effusion, hyperosteogeny and other pathology with different classification in IL-6and TNF-a level by using non-parametric Wilcoxon test shows the difference has no statistical significance (P>0.05)3. Clinical observation shows that the comparison of knee function and pain levels between preoperative treatment group and control group shows no significant difference (P>0.05). For KOA patients either purely using arthroscopic treatment or combining it with oral use of TCM Juanbi Jianxi, knee pain relief and functional improvement are clear. Besides, the effect of arthroscopic surgery combined with TCM treatment for KOA is more obvious, the difference is statistically significant (P<0.05).Conelusion1. The pathology manifestation of intra-articular structure of patients with knee osteoarthritis can be directly reflected under arthroscope. This study aims to assess the severity of osteoarthritis by observing pathological changes in synovial hyperplasia, cartilage damage, meniscus injury, hyperosteogeny, joint mouse, joint effusions and other diseases. Meanwhile, it explores the correlation between various pathological manifestations under arthroscope and TCM syndrome types. The study shows there is significant difference in pathological change severity of various syndrome types like cartilage damage, synovial hyperplasia, osteoarthritis and joint effusion and etc.2. The result of this study illustrates the pathology manifestation of KOA patient’s knee joint cavity tissue is related with the level of IL-6and TNF-α. IL-6and TNF-α level in serum can reflect pathological change severity of KOA cartilage, synovitis to some extent.3. Clinical effect observation shows that knee pain relief and functional improvement for KOA patients are clear no matter purely use arthroscopic surgery or combine it with TCM syndrome differentiation treatment. Besides, the effect of arthroscopic surgery combined with Chinese medicine treatment for KOA is more obvious.