| Objective:To systematically review the clinical efficacy and safety of drug therapy of KOA?Knee Osteoarthritis,KOA?with integrated traditional Chinese and Western medicine;to observe the clinical efficacy and safety of chitosan combined with Quhanzhufeng Mixture in the treatment of mild and moderate wind-cold-dampn-ness arthralgia type KOA;To provide evidence-based recommendations for clinical decision-making of KOA treated with integrated traditional Chinese and Western medicine.Methods:?1?systematic review:based on electronic database retrieval,suppleme-nted by manual search,searched and included in the randomized controlled trial of integrated traditional Chinese and Western medicine for the treatment of knee osteoarthritis,literature data extraction,evaluation of the quality of the included studies,statistical analysis used Review manager 5.3 software for analysis.?2?Clinical efficacy observation study:The prospective randomized controlled trial research method was used to design and implement the study.According to the inclusion criteria of the National Traditional Chinese Medicine Administration of the People's Republic of China on the clinical diagnosis of knee rickets,the inclusion of voluntary and informed TCM syndrome is cold.Subjects with wet sputum and mild to moderate knee osteoarthritis were randomized using SPSS software[1].After statistical analysis,there was no significant difference in gender,age and other general data between the two groups?P>0.05?,and there was comparability between the groups.The basic treatment of the two groups of subjects were treated with medical Chitosan intra-articular injection.In addition,the experimental group was combined with oral Chinese medicine preparation,Quhanzhufeng mixture,and the completion time of one treatment cycle in this study was 6 weeks.VAS?Visual Analogue Scale,VAS?score[2],WOMAC?Western Ontario McMaster Universities Osteoarthritis Index,WOMAC?hip and knee arthritis index[3]for clinical efficacy evaluation,before treatment,at the end of treatment,at the end of treatment After the third and sixth months,the efficacy evaluation index was collected.The color of the knee joint was measured by color ultrasound before and after the treatment,and the changes of synovial thickness and fluid volume were observed.The liver and kidney were monitored by collecting venous blood samples from the subjects.The function was to follow up whether the subject had an adverse event during the clinical trial observation.The data collected above were analyzed by SPSS 22.0 analysis software,and if P<0.05,it was considered statistically significant.Results:?1?Systematic review:A total of 1920 articles,including 551 in English and 1369 in Chinese,were searched in this study.Thirty-three randomized controlled trials of KOA treated with integrated traditional Chinese and Western medicine were included.The analysis showed that integrated traditional Chinese and Western medicine had a more significant effect on improving WOMAC score and clinical efficiency compared with the control intervention of traditional Chinese medicine and Western medicine alone.There was no statistical difference in the adverse reaction rate between the two groups.The rhombic square seen in the combined effect amount and subgroup analysis intersected with the equivalent vertical line,suggesting that there was no difference in the safety between the traditional Chinese medicine combined with western medicine and other combination of drug therapies.The quality of research methods obtained is generally low and heterogeneous.?2?Clinical efficacy observation study:The clinical symptoms and signs of the experimental group and the control group were improved to different degrees after the completion of the drug treatment in the study.Among them,2 cases were clinically cured in the experimental group,15 cases were effective,and the curative effect was acceptable.In 10 cases,3subjects had no improvement after treatment,and the total effective rate was 90%.The control group received 2 clinical cures,15 patients with good curative effect,9patients with curative effect,and 4 patients.The tester did not see obvious effect,and the total effective rate was 86.67%.Therefore,in terms of total clinical effectiveness,it can be seen that the subjects in the test group were higher than the control group?P<0.05?.VAS scores and WOMAC scores were significantly improved in both groups at the completion of treatment,at the 3rd month and 6th month after treatment,and before treatment.The VAS score of the 6th month after the completion of treatment in the experimental group was better than that of the control group.?P<0.05?,there was no significant difference between the VAS score and the control group at the completion of treatment and the completion of the treatment?P>0.05?.The WOMAC score increased at the completion of the treatment and in the third and sixth months after the completion of the treatment.The degree was greater than that of the control group?P<0.05?.The results of B-type color high-frequency ultrasound showed that the amount of fluid in the joint cavity decreased in the 6th month after the completion of treatment?P<0.05?,and the amount of fluid in the joint cavity of the experimental group.The decrease was more pronounced than the control group.In the6th month after the completion of treatment,the thickness of the cartilage layer and the thickness of the synovial layer in the upper bearing area of the femoral condyle were not significantly thickened or thinned?P>0.05?.The two groups of subjects underwent the femoral condyle bearing in the 6th month after the completion of treatment.There was no significant difference in the thickness of cartilage layer and the thickness of joint synovial layer?P>0.05?.There was no significant difference in liver function and renal function after treatment?P>0.05?.There were no serious adverse events during the treatment and follow-up,and no drug-related adverse reactions occurred.There was no statistically significant difference in the safety of medication between the two groups.Conclusions:?1?The drug therapy of KOA with integrated traditional Chinese and Western medicine has certain advantages,and its overall efficacy is better than that of traditional Chinese medicine or western medicine alone,but the incidence of adverse events is not different.?2?Quhanzhufeng Mixture combined with chitosan intra-articular injection and Etocoxib tablet combined with chitosan intra-articular injection in the treatment of KOA can improve the clinical symptoms of mild to moderate KOA of wind-cold-dampness arthralgia type.There is no difference in the safety of the two groups. |
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