关节镜下膝关节有限清理术治疗膝关节骨性关节炎疗效观察

目的:研究探讨给予膝关节骨性关节炎患者关节镜下膝关节有限清理术进行治疗的效果。方法:选取2015年~2016年我院接收的50例膝关节骨性关节炎的门诊患者,给予患者关节镜下有限清理术,利用HSS评定系统和Denis疼痛测定法对患者进行评分,并判断该方法的取得的效果。结果:根据HSS膝关节评定系统评分显示,治疗后的优良率(78.0%)明显比治疗前(18.0%)高,另外治疗后Ⅰ级的患者例数大大提高,经SPSS17.0软件分析得P<0.05,即存在统计学意义。结论:关节镜下对患者行膝关节有限清理术的治疗效果较好,能减轻患者的疼痛,值得推广于临床。

中期膝关节骨性关节炎关节镜清理术的疗效分析

目的探讨关节镜清理术对中老年中期膝关节骨性关节炎的临床应用价值。方法根据美国风湿病学学会（ARA）标准，选取89例中期膝关节骨性关节炎患者，年龄40～72岁，A组：43例，采用关节镜清理术联合术后关节腔内注射透明质酸钠和膝关节物理治疗。B组：46例，单纯关节腔内注射透明质酸钠和物理治疗。两组治疗前和治疗后2年行Lysholm膝关节综合评分。结果治疗后两年，2组Lysholm膝关节综合评分与治疗前比较均有明显提高（P〈0．05），但两组间比较无明显的差异性（P〉0．05）。结论中老年中期膝关节骨性关节炎患者选择透明质酸钠关节腔内注射结合物理治疗，能明显缓解临床症状，提高关节功能，联合采用关节镜清理术治疗没有未提高患者的远期疗效。

Factors associated with balance function in patients with knee osteoarthritis:An integrative review

This integrative review is to identify the factors associated with balance function in patients with knee osteoarthritis and explore the relationship between these factors and balance function.Osteoarthritis commonly occurs in elderly people.Patients with knee osteoarthritis have balance impairment,and maintaining knee stability is important for such patients to prevent accidental injuries caused by falling.Therefore,it is important to clarify the factors related to balance function in patients with knee osteo-arthritis.The PubMed,Science Direct,CINAHL,Ovid,ProQuest,CNKI,WanFang databases were searched,and relevant articles published up to December 2015 were included.Twenty articles were included in the analysis.Age,gender,dominant limb,foot length,knee alignment,diurnal variation,and meniscus tears were the non-modifiable factors,whereas body mass index,knee pain,muscle strength,joint range of motion,severity,and cognitive loading were the modifiable factors.Knee sleeve and custom-molded insoles showed protective effects against knee osteoarthritis.

Influencing factors analysis of spontaneous knee joint osteoarthritis among middle aged and old aged pople in Xi'an

Objective:To explore the prevalence rate of knee joint osteoarthritis and its pathogenetic fea- tures among the middle-aged and old aged people in the urban and rural area of Xi'an.Methods:From May to October 2005,1538 Han nationality above 40 years in Xi'an were investigated according to strati- fied and cluster random sampling.The same questionnaire was delivered to subjects who had been given normotopia and lateral position radiographic examination in both knees.Excluded from etiological arthri- tis,some subjects with clinical symptoms and a radiographic grade (beyond Kellgren & Lawrence gradeⅡ) were finally diagnosed as spontaneous knee joint osteoarthritis.All analyses were performed with SPSS 13.0 and t test,U test.Single factor analysis and multiple logistic regression analysis were used to analyze dates.Results:The total prevalence of spontaneous knee joint osteoarthritis was 12.1% with 2.5% and 2.1% for right and left knees,respectively.The prevalence of knee joint osteoarthritis in wom- en was 2.5 times of that in men (17.2% vs 6.8%,P=0.000).the osteophyte prevalence in women was 2.3 times of that in men (26.5% vs 11.4%,P=0.000).The prevalence of knee joint osteoarthritis and osteophyte increased with the growth of age.So did the symptomatic knee,except for the age group of 56- 60 years and 66-70 years.The prevalence of symptomatic knee joint for urban area was significantly higher than that for rural area (56.3% vs 45.3%,P=0.003).In women,the prevalence of knee joint os- teoarthritis increased significantly with the increasing of body mass index,which had not been observed in men.Female and obesity are the risk factors for osteoarthritis,but bean and its products and meat could prevent the osteoarthritis.Conclusion:Old age,female and obesity serve as risk factors for knee joint os- teoarthritis.

Regenerative Engineering for Knee Osteoarthritis Treatment： Biomaterials and Cell-Based Technologies

Knee osteoarthritis （OA） is the most common form of arthritis worldwide. The incidence of this disease is rising and its treatment poses an economic burden. Two early targets of knee OA treatment include the predominant symptom of pain, and cartilage damage in the knee joint. Current treatments have been beneficial in treating the disease but none is as effective as total knee arthroplasty （TKA）. However, while TKA is an end-stage solution of the disease, it is an invasive and expensive procedure, Therefore, innovative regenerative engineering strategies should be established as these could defer or annul the need for a TKA. Several biomaterial and cell-based therapies are currently in development and have shown early promise in both preclinical and clinical studies. The use of advanced biomaterials and stem cells independently or in conjunction to treat knee OA could potentially reduce pain and regenerate fo- cal articular cartilage damage. In this review, we discuss the pathogenesis of pain and cartilage damage in knee OA and explore novel treatment options currently being studied, along with some of their limitations.

Effect of Osteoarthritis Patients' Gender on Rehabilitation after Total Knee Arthroplasty

Objective To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty(TKA).Methods We prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008.The age and body mass index of male and female patients were matched.The surgical and rehabilitation clinical factors were compared between two groups.Results There was no significant difference in postoperative hospitalization time,surgical tourniquet time,and wound drainage volume between two groups(P>0.05).The extension/flexion degrees of knee joint before operation,1-week,2-week and 1-year after operation for male patients were 6.0 ± 3.3 degrees/ 114.0 ± 10.0 degrees,2.0 ± 1.6 degrees/93.0 ± 7.4 degrees,0.6 ± 0.6 degrees/104.0 ± 9.9 degrees and 0.3 ± 0.5 degrees/125.0 ± 8.8 degrees,for female patients were 7.0 ± 3.4 degrees/112.0 ± 14.0 degrees,2.0 ± 1.3 degrees/89.0 ± 10.9 degrees,0.9 ± 0.8 degrees/101.0 ± 11.8 degrees,0.4 ± 0.5 degrees/124.0 ± 7.1 degrees.The range of motion before operation,1-week,2-week,and 1-year after operation for male patients was 108.0 ± 9.5 degrees,91.0 ± 7.1 degrees,103.0 ± 9.9 degrees,and 125.0 ± 8.9 degrees,for female patients was 105.0 ± 14.1 degrees,87.0 ± 11.4 degrees,100.0±11.9 degrees,and 124.0 ± 7.0 degrees.The preoperative and 1-year postoperative HSS scores were 55.8 ± 13.3 and 89.6 ± 6.7 for males and 54.5 ± 13.8 and 89.2 ± 4.1 for females.No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion,range of motion and HSS score(P>0.05).Conclusions Gender does not influence postoperative knee function of osteoarthritis patients.TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

Drainage does not Promote Post-operative Rehabilitation After Bilateral Total Knee Arthroplasties Compared With Nondrainage

Objective To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties(TKA).Methods A prospective study including 40 patients was conducted.These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team.A suction drainage was placed by randomization in only one knee for each patient,while the other knee as self-control.Pain visual analogue scale score,extremity swelling,wound healing,range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically.Results Each patient was followed up for 12 months.Placing drainage did not relieve the pain,extremity swelling,ecchymosis,or reduce the incidence of early complications(all P>0.05).Conclusions Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA,compared with nondrainage.On the other hand,it might complicate the surgical operation,and increase the incidence of post-operative hemorrhage and retrograde infection.Thus we do not recommend suction drainage in unsophisticated TKA.

A randomized controlled trail on the treatment of knee osteoarthritis with acupotomy therapy based on the meridian sinew theory

Objective: To compare the clinical efficacy differences of acupotomy therapy guided by the meridian sinew theory and acupotomy therapy guided by the anatomy theory of western medicine in the treatment of knee osteoarthritis.Methods: Sixty-three patients were randomly divided into the acupotomy group of the meridian sinew theory(Group A, n = 32) and the acupotomy group of the anatomy theory(Group B. n = 31). For Group A, with positive reaction points such as the tenderness points of three yang meridians and three yin meridians of the foot, and funicular nodules as the points of needle insertion, the needle-knife, after disinfection and anesthesia, gives priority to longitudinal dissection after insertion, and then carries out subcutaneous sweeping maniplation. For Group B, with 8 points for needle insertion, including the origins and terminations of the medial and lateral collateral ligaments, the origins and terminations of the patellar ligament, the terminations of the quadriceps femoris tendon, and pes anserinus bursa point, the treatment was performed in strict accordance with the four-step procedures of acupotomy(positioning,orientating, pressurizing to separate, and puncturing) after disinfection and anesthesia. The treatment was conducted once a week and three times in total. Statistical analysis was conducted with the Western Ontario and McMaster Universities(WOMAC) Osteoarthritis Index and Visual Analogue Scale(VAS)for overall pain before treatment and at week 2 and 4 during treatment, and the adverse reactions of patients were observed and recorded to evaluate the curative effect.Results: During the treatment period, the overall response rates(ORRs, that is markedly effective + effective) were compared between the two groups. The ORR of Group A was 90.63% and that of Group B was 87.09%. There was no statistical significant difference between the two groups(P>0.05).After treatment, the WOMAC function score of Group A was significantly lower than that before treatment(17.28 ±10.22 vs 32.75 ± 14.88, P <0.001), and that of Group B was lower than that before treatment(24.87 ±16.48 vs 30.90 ±16.64, P< 0.05). there was a statistical significant difference between the two groups(P<0.05). As for the comparison of VAS pain scores, in Group A, there was statistical significant difference(4.48 ± 1.60 vs 5.05 ± 1.60. P< 0.05) between at Week 2 and before treatment, and statistically significant difference(1.88 ± 1.03 vs 5.05 ± 1.60, P<0.001) between at Week 4 and before treatment.In Group B, there was no significant difference(P>0.05) between at Week 2 and before treatment, and there was statistically significant difference(3.31 ± 1.56 vs 4.77 ± 1.68, P<0.001) between at Week 4 and before treatment. The VAS pain score of Group A was significantly lower than that of Group B(P< 0.001),and 2 cases of mild adverse reactions occurred in Group A and 3 in Group B.Conclusion: Both acupotomy therapies guided by the meridian sinew theory and by the anatomy theory of Western medicine have good curative effect on knee osteoarthritis, but acupotomy guided by the meridian sinew theory has more superiorities in operability, safety and effectiveness, which is easy to be generalized in grass-roots and community hospitals.

Clinical Observation on Curative Effect of Dissolving Phlegm-Stasis on 50 Cases of Knee Osteoarthritis

Objective： To observe the curative effect of dissolving phlegm-stasis on knee osteoarthritis. Methods： The 100 patients with knee osteoarthritis were randomly divided into two groups. The 50 patients in the treatment group orally took Chinese medicine while the other 50 patients in the control groups orally took Votalin and Vitamin C for one week as a course of treatment. At the end of 2-week treatment, analytic comparison was carried in evaluate the curative effect and the changes in total score of symptoms before and after treatment between the two groups. Results： The total score of symptoms after treatment was significantly lower than that before treatment in both groups （P〈0.01, P〈0.05）. The total score after treatment of patients with X-ray grade I and II in the treatment group was more obviously reduced as compared to the control group （P〈0.05）. The remarkably effective rate after treatment of patients with X-ray grade I and It in the treatment group was also higher than that in the control group （P〈0.05）. Conclusion： The treatment of knee osteoarthritis with dissolving phlegm-stasis can effectively improve the clinical symptoms.

Effect of Huqian Wan on liver-Yin and kidney-Yin deficiency patterns in patients with knee osteoarthritis

OBJECTIVE: To observe the curative effect of Huqian Wan on liver and kidney-Yin deficiency knee osteoarthritis(KOA).METHODS: One hundred patients were randomly divided into a treatment(50 patients) and control group(50 patients). In the treatment group, patients orally took the Chinese medicine Huqian Wan. Control group patients orally took Votalin, 75 mg, once a day, for 8 weeks. The visual analog scale(VAS), Western Ontario and Mc Master University Osteoarthritis Index(WOMAC), and Medical Outcomes Study Short Form 36-Item Health Survey(SF36) were used to evaluate the curative effect before treatment and after 8 and 16 weeks of treatment.RESULTS: VAS and WOMAC scores significantly decreased and SF 36 scores significantly increased after treatment in both groups compared with before treatment(P < 0.05). There were significant differences in VAS, WOMAC, and SF 36 score changes between the two groups at week 16(P < 0.05).There was a significant increase in VAS and WOMAC scores in the control groups(P < 0.05) between weeks 8 and 16, but no significant difference was found in the treatment group(P > 0.05).CONCLUSION: Huqian Wan could effectively improve the clinical symptoms and quality of life in patients with KOA. It could also have a better and longer lasting curative effect without obvious adverse events compared with Votalin.

Quality assessment of randomized controlled trials reporting on knee osteoarthritis treated with warming needle moxibustion

OBJECTIVE: To evaluate the quality of randomized controlled trials(RCTs) testing the efficacy of warming needle moxibustion on knee osteoarthritis(KOA).METHODS: Nine databases were searched systematically including: the Cochrane Library(1/1993-10/2012), Pub Med(1/1980-10/2012), EMBASE(1/1990-10/2012), SCI Expanded(1/1986-10/2012), Science Direct(1/1979-10/2012), Chinese Biomedical Literature Database disc(1/1978-10/2012), China National Knowledge Infrastructure Database(1/1979-10/2012), China Science and Technology Journal Database(a full text issue database of China, 1/1989-10/2012), and Wanfang Database(a full text issue database of China, 1/1990-10/2012). Traditional reference retrieval was also conducted. Language was limited to Chinese and English. We identified 37 RCTs that used warming needle moxibustion as an intervention and they were assessed with the Consolidated Standards for Reporting of Trials Statement 2010(CONSORT 2010) and Standards for Reporting Interventions Controlled Trials of Acupuncture 2010(STRICTA 2010).RESULTS: Of the 37 reports, only seventeen(45.95%) mentioned the random allocation of sequence methods, nine used unacceptable methods, and only one(2.70%) gave the description of the mechanism of allocation concealment. One study(2.70%) mentioned blinding, one(2.70%) had a sample size calculation, and twenty-three(62.16%) used reasonable statistical methods. Thirteen(35.14%) described the background and reason for the RCTs, three(8.11%) gave a description of lost or eliminated patients, and two(5.41%) reported accidental situations. Only three(8.11%)gave analysis of the RCT limitations. No report mentioned intentional analysis.CONCLUSION: The quality of the RCTs assessed in this study was from moderate to low. The design of RCTs, the methods of statistical analysis, and the description of reports information needs to be improved. CONSORT 2010 and STRICTA 2010 should be used to standardize the reporting of acupuncture RCTs in the future.