| BackgroundIn terms of traditional Chinese medicine,knee bone disease due to wind,cold,wet,heat,and other evils that block the meridians and affect the operation of Qi and blood,resulting in pain,weight,acid,and numbness in the bones,joints,and muscles of the limbs,osteoarthritis in Western medicine.Or a disease with adverse flexor,stiffness,swelling,deformation,and other symptoms of the joint.Clinical mainly divided into rheumatism,rheumatism,rheumatism,phlegm and phlegm and kidney deficiency deficiency syndrome.The degeneration of knee joint is a common type of osteoarthritis(OA)whose clinical manifestations include slow-developing joint pain,tenderness,stiffness,joint swelling,limited movement and joint deformity.It will decrease the quality of advanced patients.Middle-aged and elderly people are the most vulnerable group.The severity of knee OA is related to the degree of deformity of lower limbs which can be evaluated by measuring the force line of lower limbs.It is called Knee Bone Bi In Traditional Chinese Medicine(TCM)which believe that liver and kidney deficiency,lack of positive Qi,and loss of muscle and vein can result in the formation and development of knee OA.It happens in elderly patients mostly because of the liver and kidney deficiency which is also the most common and serious type of TCM.The lower extremity force line,also known as the lower extremity mechanical shaft,is an important significance for the diagnosis,treatment,prognosis and recovery of the disease through the axis of the femoral center-the knee joint center-the ankle joint center.In particular,it is very important for artificial knee,single condylar joint replacement and osteotomy.Many studies suggest that the service life of joint replacement prostheses depends to some extent on the suitability of the force lines of the lower extremities.At present,some hospitals use non-full-length or horizontal X-rays to perform lower extremity force line measurement and formulate surgical plans.This X-ray can not reflect the patient’s true lower extremity force line.It also conceals deformities or abnormal force lines caused by the imbalance of soft tissue in the knee joint.Therefore,it is very important to take the full length of the lower extremities in the weight position to measure the force lines of the lower extremities.In previous studies,the lower limb force line was divided into invert,mid-position,and outwards according to the HKA angle.However,this classification method failed to accurately describe the abnormalities of the femur and tibia force lines.When the lower extremity force line deviates from the center of the knee joint,it does not only indicate the intraarticular deformity,but also causes the lower extremity force line deviation when the extraarticular deformity is concerned.Therefore,when there is an abnormal force line of the lower extremity,that is,joint deformity,it is necessary to determine whether the deformity comes from inside or extra-articular the joint.If it is an extraarticular deformity,the deformity should be distinguished from the femoral side or the tibia side;If the LDFA is less than the standard value,the overturning deformity originates from the femur side;MPTA decreases,the varus deformity originates from the tibia side.ObjectiveTo classify different types of lower limb force line and further analyze the characteristic of knee OA deformity by measuring the force line of lower limb through radiography of full length of lower limbs among our survey group.Furthermore,we try to explore the types of Knee Bone Bi to provide guidance for the clinical diagnosis and treatment of it.MethodFrom January 2015 to December 2017,a total 274 knee OA patients were admitted from Department of Orthopaedics in China-Japan Friendship Hospital,including 192 females and 82,147 males.All the patients were led to make right posture to be examined for the radiography of full length of the lower limbs,and the full length of the lower limbs was carried out by the computer image assisted system.We got 500 lower limbs full length films of knee joint(including the injured side and healthy side).All the data were analyzed by SPSS 21.0 statistical software.Grouping analysis was according to age,gender,internal and external turns and internal and external joint deformities.The measurement data were expressed by mean ± standard deviation and count date by number.The data wer tested by variance analysis and independent sample T test.The difference was statistically significant with P<0.05.Results500 knees joint full length of lower limbs were measured among 274 patients,including 147 males and 353 females.The average age was 67.5 ± 8.7 years old.The HKA range was 160.7 °～187.6 °,with an average 175.7 ° ± 4.1 °.The LFDA range was 79.4 °～92.9 °,with an average of 87.8 ° ± 1.9 °.The MPTA range was 78.0 °～91.2 °with an average of 86.1 ° ± 2.3 °.In 285 cases of knee varus,78 existed single extra-articular deformity and 51 existed single intra-articular deformity.156 existed mixed deformities.In the 10 cases of knee valgus,4 were extra-articular deformities and 6 were mixed.Among the 78 cases of knee varus in the non-surgical group HKA,MPTA of 62 cases was less than the standard value(87 °),indicating that the tibial side deformity are the main reason of extra-articular deformity accounting for 79.5%.Among the 4 cases of keen varus in non-surgical group HKA,all the LDFA was less than the standard value(87 °),indicating that the formal side deformity are the main reason of extra-articular deformity,accounting for 100%.It is consistent with previous studies.ConclusionFor patients with knee OA,lower limbs force line measurement should be classified to clear the situation of lower limbs force line,and then carry out the treatment plan.We should not only consider the intra-articular deformities but also consider the extra-articular and mixed types.For the extra-articular deformities,it is also necessary to distinguish the femoral and the side.In addition,Chinese medicine syndrome types should also be identified.The TCM treatment includes strengthening the body and eliminating pathogens,considering both the incidental and fundamental to balance the human body Yin and Yang as well as viscera functions.Forming a complete and effective classification and treatment system by the integration of Chinese and western medicine to judge the severity of knee OA and provide more effective prevention and treatment for knee OA. |
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