膝骨关节炎经筋辩证分型与骨髓水肿相关性研究
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摘要
目的：
膝关节是骨关节炎发病的最常见部位之一,膝骨关节炎是一种日常生活中的多见病,由于严重影响患者生活质量,故日益受到人们的重视。随着中医学和现代医学在防治膝骨关节炎的发生、发展的研究不断深入,人们对其的认识不断深刻。本课题组一直致力在膝骨关节炎经筋辨证理论的研究探索。通过临床观察,我们发现了膝骨关节炎的“筋痹”及“骨痹”两个重要阶段是密不可分的,两者相互影响,相互作用,并对膝骨关节炎的发生及发展有着深远的影响。本课题组以往研究表明,从“筋痹”发展至“骨痹”的过程,经筋一直起着重要的作用。膝骨关节炎的“筋痹”阶段是本病发展过程中的最初及必经阶段,而经过病程发展,最终出现“骨痹”,故我们认为“骨痹”阶段是“筋痹”阶段发展过程的延伸。近年来,膝关节流行病学研究表明：骨髓水肿(bone marrow edema, BME)在退行性骨关节炎中是很常见的,并且是病情加重的常见的危险因素之一。本课题立意在于探讨膝骨关节炎的“筋痹”及“骨痹”两个阶段对膝骨关节炎发生及发展的重要性。“筋痹”即经筋病变,“骨痹”与现代医学骨髓水肿相近似。所以,本课题通过临床试验,探讨膝骨关节炎经筋辨证及骨髓水肿的相关性,为骨髓水肿作为膝骨关节炎经筋辨证客观证据提供临床基础；并且藉此证明“筋痹”与“骨痹”两者影响膝关节炎的发生及进展：“筋痹”及“骨痹”阶段是同时存在的,即使在经筋病变的早期阶段,而到了膝骨关节炎的“骨痹”中后期阶段,经筋仍然起着重要作用；通过经筋疗法治疗膝骨关节炎,能达到“筋痹”及“骨痹”同治的效果!
方法：
为探讨两者的关系,在本论文的第二部分中,我们选取108例膝骨关节炎患者,按照国家中医药管理司医政司《22个专业95个病种中医诊疗方案》中关于膝痹病(膝关节骨关节炎)的诊疗方案,并按中科院颁布的《经筋病诊断标准》对病例进行辨证,将膝骨关节炎分型,分析其分布规律并与膝骨关节炎骨髓水肿病变情况的关系；同时研究骨髓水肿与膝骨关节炎X线分期、疼痛症状的关系,进而探讨骨髓水肿病变在膝骨关节炎经筋辨证中的作用。其中105例膝骨关节炎患者,经筋辨证分型后,运用经筋疗法进行治疗,并通过WOMAC评分、骨髓水肿评分前后对比,探求经筋疗法的治疗有效性。
结果：
第二部分中,108例膝骨关节炎患者X线、骨髓水肿与经筋分型进行相关性分析。其中重度X线表现占疼痛患者90%,表明中重度X线患者疼痛程度比轻度X线患者高,但疼痛分级与X线分级的列联表的χ2检验显示,膝关节疼痛分级与X线分级无关(χ2=3.791, P=0.435)；多个独立样本比较秩和检验结果显示,三个疼痛组的X线分级的差异没有统计学意义(P=0.305)；重度骨髓水肿中存在重度疼痛占93.24%；轻度疼痛患者中,只有29.4%的患者存在骨髓水肿；中重度疼痛患者中,有75.8%患者存在1级以上骨髓水肿。疼痛与骨髓水肿的卡方检验提示,疼痛程度与骨髓水肿分级有关(χ2=20.254,P<0.01),多个独立样本比较秩和检验结果显示,三组病例骨髓水肿分级的差异存在统计意义(P<0.05),并且研究结果显示：随着疼痛程度的不断加重,骨髓水肿分级的平均秩次逐渐加大(0级为41.01,1级为52.85,2级为66.21),这也显示骨髓水肿与疼痛有关；膝骨关节炎患者疼痛程度与骨髓水肿spearman相关分析提示：疼痛程度与骨髓水肿之间存在相关性(P<0.01)。研究结果提示我们：骨髓水肿与疼痛有关,并且随着疼痛的加重,骨髓水肿也有加重的趋势。
经筋病变中,中重度骨髓水肿占89.13%,经筋分型与骨髓水肿卡方检验,提示经筋分型与骨髓水肿分级有关(χ2=14.959,P<0.01),另外,经筋分型与骨髓水肿的秩和检验研究结果显示：随着经筋合病程度的不断加重,骨髓水肿分级的平均秩次逐渐加大(0级为48.42,1级为59.74,2级为82.42),这也显示骨髓水肿与经筋分型有关。
通过经筋疗法治疗膝骨关节炎,包括经筋手法(M组)及火针疗法(F组)治疗经筋辨证分型膝骨关节炎患者并与口服塞来昔布组(0组)对比,通过WOMAC评分(疼痛、关节僵直程度、活动程度)及骨髓水肿分级评分检验经筋疗法的有效性。M组治疗前疼痛评分为10.89±3.636,F组治疗前疼痛评分为9.57±4.313,0组治疗前疼痛评分为10.60±3.950,三组治疗前疼痛评分方差分析(P>0.10),提示三组治疗前疼痛评分无差别；M组治疗后疼痛评分为5.74±3.257,F组治疗后疼痛评分为6.11±3.546,0组治疗后疼痛评分为8.11±3.948,三组治疗后疼痛评分两两对照,M组、F组之间对比P>0.10,两组治疗后疼痛评分无差异；M组与0组之间对比,P<0.10,提示两组治疗后疼痛评分有差异；F组与0组之间对比,P<0.10,提示两组治疗后疼痛评分有差异；M组、F组明显优于0组。M组治疗前僵硬程度评分为4.17±2.007,F组治疗前疼痛评分为3.97±2.121,0组治疗前疼痛评分为3.71±2.122,三组治疗前方差分析(P>0.10),提示三组治疗前僵硬评分无差别；M组治疗后僵硬程度评分为3.11±1.762,F组治疗前疼痛评分为3.17±1.902,0组治疗前疼痛评分为3.29±1.903,三组治疗后僵硬程度评分方差分析(P>0.10),提示三组治疗后僵硬评分无差别。M组治疗前日常活动评分为36.00±14.801,F组治疗前日常活动评分为36.69±15.231,0组治疗前日常活动评分为33.00±15.282；三组治疗前日常活动评分方差分析(P>0.10),提示三组治疗前日常活动评分无差别。M组治疗后日常活动程度评分为21.57±10.869,F组治疗后日常活动评分为21.89±11.303,0组治疗后日常活动评分为27.89±14.481；三组治疗后活日常活动评分两两对照,M组、F组之间对比P>0.10,两组治疗后日常活动评分无差异；M组与0组之间对比,P<0.10,提示两组治疗后日常活动评分有差异；F组与0组之间对比,P<0.10,提示两组治疗后日常活动评分有差异；M组、F组明显优于0组。M组、F组、0组治疗前骨髓水肿评分,通过卡方检验,提示之间的差别不具有统计学意义(p=0.860)；治疗后三组之间的骨髓水肿分布情况通过卡方检验提示,三组之间差别具有统计学意义；并提示F组的0级水肿的发生率高于其他组别,而0组的0级水肿的发生率低于其他组别。M组、F组在骨髓水肿程度上,治疗后优于0组。
结论：
1、本研究显示在膝骨关节炎患者疼痛程度与骨髓水肿存在相关性。通过本课题研究,三个疼痛组(轻、中、重程度)的骨髓水肿发生率存在的差异有统计学意义,即随膝骨关节炎患者疼痛程度的加重骨髓水肿程度也有加重的趋势。
2、骨髓水肿已作为膝骨关节炎一个客观的量化指标用于临床上。由于膝关节应力的集中,导致膝关节力学平衡改变,并且筋膜和肌肉经反复的劳损,出现代偿性、增生性肥厚,加重膝软骨损伤。经筋组织为适应病变后的高应力,产生相应的变化。这些经筋病变加重膝骨关节炎病变程度,形成及加重骨髓水肿。基于此理论基础,本课题开展了关于经筋病症分型及骨髓水肿的相关性研究,并得到了随着膝骨关节炎经筋病变程度加重,骨髓水肿程度加重的研究结果。
3、经筋疗法治疗通过使用经筋手法及火针疗法治疗膝骨关节炎,分别对照治疗前及治疗后疼痛、僵硬程度、活动程度、骨髓水肿程度等。结果表明,两种经筋疗法对经筋分型膝骨关节炎治疗有明显疗效,并经筋疗法治疗组效果优于口服塞来昔布组。
4、经筋疗法,即通过手法“梳理”经筋走向、“松解”筋结点等肌肉、筋膜挛缩反应点,以及针对筋结点、筋聚点进行火针散刺。治疗经筋辨证分型膝骨关节炎,具有操作方法简单、效果明显并且安全性高等优点。通过经筋疗法针对“筋结点”的治疗,不但使经筋病的“筋痹”达到治疗效果,而且能改善膝部力学平衡状态及膝骨关节炎骨髓水肿(即“骨痹”状态)情况。通过经筋疗法治疗膝骨关节炎,可以达到“筋痹”及“骨痹”同治的效果!经筋疗法,为治疗膝骨关节炎提供一个安全有效的治疗方法,具有临床推广的意义。
5、经筋病变是膝骨关节炎“筋痹”,骨髓水肿是膝骨关节炎“骨痹”。本课题从临床试验,客观验证“筋痹”及“骨痹”阶段是同时存在的,即使在经筋病变的早期阶段,而到了膝骨关节炎的“骨痹”中后期阶段,经筋仍然起着重要作用。
Objective:
The knee is one of the most common sites of osteoarthritis, as a common disease, increasing attention has been paid on. Chinese medicine and modern medicine in the prevention of knee osteoarthritis have their growing understanding of profound. For knee osteoarthritis by Meridian-Muscle Syndrome Differentiation, our group has been committed to the direction of the research. Our studies had shown that from process of Meridian-Muscle theumatism development to Bone theumatism, Meridian-Muscle plays an important role, we believe that Meridian-Muscle theumatism is a necessary stage in the development of knee osteoarthritis, Bone theumatism is the extension of the development process of the Meridian-Muscle theumatism. In recent years, epidemiological studies of the knee have shown that bone marrow edema (BME) is a risk factor for osteoarthritis exacerbations. Bone marrow edema is very common in osteoarthritis. Through clinical trials, we had tried to explore knee osteoarthritis by Meridian-Muscle Syndrome Differentiations and Bone marrow edema. Bone marrow edema and knee osteoarthritis of through Meridian-Muscle Syndrome Differentiations can be an effective and objective evidence to provide the basis of clinical. Proved once again that knee osteoarthritis Meridian-Muscle theumatism is Bone theumatism s basic, Bone theumatism is an extension of Meridian-Muscle theumatism, Meridian-Muscle and Bone are also importance!
Method:
To explore the relationship between them, in the second part of the paper, we selected108patients with knee osteoarthritis, Knee rheumatism disease (knee osteoarthritis) in accordance with the State Pharmaceutical Management Department of Medical Administration22professional95disease TCM in treatment programs, According to the Chinese Academy of Sciences issued by the Meridian-Muscle Diagnostic criteria cases dialectical type, type the knee osteoarthritis, to analyze the distribution pattern and relationship with knee osteoarthritis and Bone marrow edema lesions. At the same time, analysis knee osteoarthritis X-ray stage with Bone marrow edema in clinical pain symptoms, thus re-examine the role of Bone marrow edema lesions in the knee osteoarthritis by Meridian-Muscle Diagnostic that has been ignored. In the third part of the paper,105patients with knee osteoarthritis patients, type by the Meridian-Muscle Diagnostic, treat with Meridian-Muscle Treatment, and with WOMAC score, Bone marrow edema score before and after comparison, to explore through the bars therapy treatment effectiveness. The results analysis statistically with SPSS13.0package, P<0.05considered to be statistically significant.
Result:
In the second part,108patients with knee osteoarthritis X-ray, through Bone marrow edema and Meridian-Muscle typing analysis their correlation. Severe X-ray findings accounted for90%of the patients with pain, show that patients with moderate to severe X-ray more pain than patients with mild X-ray, but pain ratings and X-ray classification contingency table x2test show that, Knee pain grading unrelated with X-ray grade (x2=3.791, P=0.435). Rank Sum Test results of numbers of independent samples show that X-ray classification of the three pain groups was not statistically significant (P=0.341). Severe Bone marrow edema in severe pain accounted for93.24%, patients with mild pain, only29.4%of patients with bone marrow edema. In patients with moderate to severe pain,75.8%of patients in the presence of one or more degree bone marrow edema, pain and bone marrow edema chi-square test tips show that the degree of pain relate with bone marrow edema grade (x2=20.254, P<0.01). Several independent samples comparison rank sum test results show that the three groups of patients with bone marrow edema grading have difference statistically significant (P<0.05), and research results show that:with the degree of pain has been increasing, the average rank of the bone marrow edema grading gradually increase (0degree41.01,1degree52.85,2degree66.21). It also shows that bone marrow edema relate with pain. Research results suggest that Bone marrow edema relate with pain, and with the aggravation of pain, bone marrow edema worsening trend.
The Meridian-Muscle lesions in severe bone marrow edema accounted for89.13%, Meridian-Muscle typing and bone marrow edema chi-square test, prompted that Meridian-Muscle typing relate with bone marrow edema grade (x2=14.959, P<0.01), tip that bone marrow edema type by Meridian-Muscle disease. Single Meridian-Muscle disease, two Meridian-Muscle disease and triple Meridian-Muscle disease group contrast visible, the single Meridian-Muscle disease compare with the Meridian-Muscle disease have a significant difference (P<0.05). Two Meridian-Muscle disease and three Meridian-Muscle disease has no significant difference (P>0.05). Several independent samples comparison rank sum test results show that the three groups of patients bone marrow edema grading difference statistically significant (P<0.05). And research results show that:with the degree of disease has been increasing through the Meridian-Muscle's number increased, the mean rank of the bone marrow edema grading gradually increased (0degree48.42,1degree59.74,2degree82.42), which also shows the bone marrow edema relate with Meridian-Muscle typing.
Through the Meridian-Muscle therapy, including the Meridian-Muscle massage (M group) and fire needle (F group) for the treatment on patients with knee osteoarthritis through the Meridian-Muscle Syndrome Differentiations and compare with oral celecoxib group (0group), the effectiveness of the WOMAC scores (pain, joint stiffness, activity level) and bone marrow edema rating grades inspection the Meridian-Muscle therapy. M group pre-treatment pain score was10.89±3.636, F group pre-treatment pain score was9.57±4.313,O group pre-treatment pain score was10.60±3.950, three sets of pre-treatment pain score two control, P>0.10, three groups before treatment have no difference in pain scores. M group after treatment pain score was5.74±3.257, the F treatment pain score was6.11±3.546, and the0group therapy pain score was8.11±3.948, difference between the three groups after treatment, pain score in two group, M group, F group comparison P>0.10, two groups after treatment have no different. Comparison between group M and group0, P<0.10, prompt treatment, pain score difference; Comparison between Group F and Group0, P<0.10, prompted the two groups after treatment pain score difference; M group, F group was significantly better than the0group. The M group before treatment stiff scores of4.17+2.007, the F group pre-treatment pain score was3.97±2.121,0group before treatment pain score was3.71±2.122, three groups before treatment stiffness scores two control, P>0.10, threebefore treatment, stiff rated no difference; M group treatment of stiffness after scores of3.11±1.762, F group pre-treatment pain score was3.17±1.9020group pre-treatment pain score was3.29±1.903, the stiff no difference in the ratings of the three groups after treatment. The M group before treatment activities ratings36.00±14.801, F treatment before the activity score36.69±15.231.0group before treatment activities ratings33.00±15.282; M group after treatment, the degree of activities rated21.57±10.869, F group therapy activities score was21.89±11.303,0group therapy activities score was27.89±14.481, three groups before treatment have no different P>0.05, in the ratings of three groups before treatment, activities have no difference. Activities score after treatment, M group scores21.57±10.869, F group score21.89±11.303,0group score was27.89±14.481, between the three groups score after treatment, the activities score of M group and F group comparison P>0.10, have no difference. Comparison between group M and group0, P<0.10, before treatment, activities score difference; contrast between the F group and the group0, P<0.10, prompt treatment, activities score difference; M group and F group was significantly better than the0group. The M group before therapy bone marrow edema score was2.00±0.840, F group before treatment bone marrow edema score was2.06±0.838,0group before therapy bone marrow edema score was2.17±0.822, three groups before treatment, bone marrow edema score, P>0.10, no difference in the three groups before treatment activities score. M group after treatment, bone marrow edema score of1.23±0.490, F group after treatment, bone marrow edema score was1.20±0.473,0group after treatment, bone marrow edema score was1.51±0.702; Group after treatment, bone marrow edema score between the groups, M group, F group comparison P>0.10, two groups after treatment, bone marrow edema score have no difference; comparison between group M and group0, P<0.10, prompt treatment, bone marrow edema score difference; contrast between the F group and the group0, P<0.10, prompt treatment, bone marrow edema score difference; M group, F group was significantly better than the0group.
Conclusion:
1. This study shows that patients with knee osteoarthritis, bone marrow edema (BME) correlated with knee pain. There was significant difference between the groups with pain of bone marrow edema incidence, with knee painincreased, bone marrow edema worsening trend. Typing knee osteoarthritis by Meridian-Muscle Syndrome Differentiations and bone marrow edema have correlation, the difference between the three through Meridian-Muscle groups and bone marrow edema have statistically significance, with increased knee pain, bone marrow edema worsening trend.
2. Bone marrow edema (BME) can be used as dialectically an objective quantitative indicators for clinical knee osteoarthritis of Meridian-Muscle Syndrome Differentiations. Mechanical equilibrium of the knee tendons lesions cause damage, stress concentration knee cartilage injuries were aggravated by the tendons of the human body to adapt to the presence of high stress in the lesion, the organization will produce a corresponding change. Stress concentration so that the muscle ligaments to spasm, fascia contracture, and the fascia and muscle will produce compensatory hypertrophy. In these tendon lesions lead to the knee mechanical equilibrium the limb alignment change, resulting in knee cartilage injury, adding to the severity of knee osteoarthritis, formed and increase bone marrow edema.
3. Meridian-Muscle therapy through the use of the Meridian-Muscle massage and fire needle therapy treatment of knee osteoarthritis, before and after treatment score comparison, results show that both methods by Meridian-Muscle therapy to knee osteoarthritis, the effect of the Meridian-Muscle therapy group was significantly superior to oral celecoxib group.
4. By Combing the Meridian-Muscle, Release Meridian-Muscle junction points and use fire needle treat Meridian-Muscle point of the scattered thorn treatment by gluten knee osteoarthritis, are safe operation and simple method, etc. Had provide a safe and effective treatment for patients with knee osteoarthritis, has a certain clinical significance.
5. Proved once again that knee osteoarthritis Meridian-Muscle theumatism is Bone theumatism basic, Bone theumatism is an extension of Meridian-Muscle theumatism, Meridian-Muscle and bone are also importance!
膝关节是骨关节炎发病的最常见部位之一,膝骨关节炎是一种日常生活中的多见病,由于严重影响患者生活质量,故日益受到人们的重视。随着中医学和现代医学在防治膝骨关节炎的发生、发展的研究不断深入,人们对其的认识不断深刻。本课题组一直致力在膝骨关节炎经筋辨证理论的研究探索。通过临床观察,我们发现了膝骨关节炎的“筋痹”及“骨痹”两个重要阶段是密不可分的,两者相互影响,相互作用,并对膝骨关节炎的发生及发展有着深远的影响。本课题组以往研究表明,从“筋痹”发展至“骨痹”的过程,经筋一直起着重要的作用。膝骨关节炎的“筋痹”阶段是本病发展过程中的最初及必经阶段,而经过病程发展,最终出现“骨痹”,故我们认为“骨痹”阶段是“筋痹”阶段发展过程的延伸。近年来,膝关节流行病学研究表明：骨髓水肿(bone marrow edema, BME)在退行性骨关节炎中是很常见的,并且是病情加重的常见的危险因素之一。本课题立意在于探讨膝骨关节炎的“筋痹”及“骨痹”两个阶段对膝骨关节炎发生及发展的重要性。“筋痹”即经筋病变,“骨痹”与现代医学骨髓水肿相近似。所以,本课题通过临床试验,探讨膝骨关节炎经筋辨证及骨髓水肿的相关性,为骨髓水肿作为膝骨关节炎经筋辨证客观证据提供临床基础；并且藉此证明“筋痹”与“骨痹”两者影响膝关节炎的发生及进展：“筋痹”及“骨痹”阶段是同时存在的,即使在经筋病变的早期阶段,而到了膝骨关节炎的“骨痹”中后期阶段,经筋仍然起着重要作用；通过经筋疗法治疗膝骨关节炎,能达到“筋痹”及“骨痹”同治的效果!
方法：
为探讨两者的关系,在本论文的第二部分中,我们选取108例膝骨关节炎患者,按照国家中医药管理司医政司《22个专业95个病种中医诊疗方案》中关于膝痹病(膝关节骨关节炎)的诊疗方案,并按中科院颁布的《经筋病诊断标准》对病例进行辨证,将膝骨关节炎分型,分析其分布规律并与膝骨关节炎骨髓水肿病变情况的关系；同时研究骨髓水肿与膝骨关节炎X线分期、疼痛症状的关系,进而探讨骨髓水肿病变在膝骨关节炎经筋辨证中的作用。其中105例膝骨关节炎患者,经筋辨证分型后,运用经筋疗法进行治疗,并通过WOMAC评分、骨髓水肿评分前后对比,探求经筋疗法的治疗有效性。
结果：
第二部分中,108例膝骨关节炎患者X线、骨髓水肿与经筋分型进行相关性分析。其中重度X线表现占疼痛患者90%,表明中重度X线患者疼痛程度比轻度X线患者高,但疼痛分级与X线分级的列联表的χ2检验显示,膝关节疼痛分级与X线分级无关(χ2=3.791, P=0.435)；多个独立样本比较秩和检验结果显示,三个疼痛组的X线分级的差异没有统计学意义(P=0.305)；重度骨髓水肿中存在重度疼痛占93.24%；轻度疼痛患者中,只有29.4%的患者存在骨髓水肿；中重度疼痛患者中,有75.8%患者存在1级以上骨髓水肿。疼痛与骨髓水肿的卡方检验提示,疼痛程度与骨髓水肿分级有关(χ2=20.254,P<0.01),多个独立样本比较秩和检验结果显示,三组病例骨髓水肿分级的差异存在统计意义(P<0.05),并且研究结果显示：随着疼痛程度的不断加重,骨髓水肿分级的平均秩次逐渐加大(0级为41.01,1级为52.85,2级为66.21),这也显示骨髓水肿与疼痛有关；膝骨关节炎患者疼痛程度与骨髓水肿spearman相关分析提示：疼痛程度与骨髓水肿之间存在相关性(P<0.01)。研究结果提示我们：骨髓水肿与疼痛有关,并且随着疼痛的加重,骨髓水肿也有加重的趋势。
经筋病变中,中重度骨髓水肿占89.13%,经筋分型与骨髓水肿卡方检验,提示经筋分型与骨髓水肿分级有关(χ2=14.959,P<0.01),另外,经筋分型与骨髓水肿的秩和检验研究结果显示：随着经筋合病程度的不断加重,骨髓水肿分级的平均秩次逐渐加大(0级为48.42,1级为59.74,2级为82.42),这也显示骨髓水肿与经筋分型有关。
通过经筋疗法治疗膝骨关节炎,包括经筋手法(M组)及火针疗法(F组)治疗经筋辨证分型膝骨关节炎患者并与口服塞来昔布组(0组)对比,通过WOMAC评分(疼痛、关节僵直程度、活动程度)及骨髓水肿分级评分检验经筋疗法的有效性。M组治疗前疼痛评分为10.89±3.636,F组治疗前疼痛评分为9.57±4.313,0组治疗前疼痛评分为10.60±3.950,三组治疗前疼痛评分方差分析(P>0.10),提示三组治疗前疼痛评分无差别；M组治疗后疼痛评分为5.74±3.257,F组治疗后疼痛评分为6.11±3.546,0组治疗后疼痛评分为8.11±3.948,三组治疗后疼痛评分两两对照,M组、F组之间对比P>0.10,两组治疗后疼痛评分无差异；M组与0组之间对比,P<0.10,提示两组治疗后疼痛评分有差异；F组与0组之间对比,P<0.10,提示两组治疗后疼痛评分有差异；M组、F组明显优于0组。M组治疗前僵硬程度评分为4.17±2.007,F组治疗前疼痛评分为3.97±2.121,0组治疗前疼痛评分为3.71±2.122,三组治疗前方差分析(P>0.10),提示三组治疗前僵硬评分无差别；M组治疗后僵硬程度评分为3.11±1.762,F组治疗前疼痛评分为3.17±1.902,0组治疗前疼痛评分为3.29±1.903,三组治疗后僵硬程度评分方差分析(P>0.10),提示三组治疗后僵硬评分无差别。M组治疗前日常活动评分为36.00±14.801,F组治疗前日常活动评分为36.69±15.231,0组治疗前日常活动评分为33.00±15.282；三组治疗前日常活动评分方差分析(P>0.10),提示三组治疗前日常活动评分无差别。M组治疗后日常活动程度评分为21.57±10.869,F组治疗后日常活动评分为21.89±11.303,0组治疗后日常活动评分为27.89±14.481；三组治疗后活日常活动评分两两对照,M组、F组之间对比P>0.10,两组治疗后日常活动评分无差异；M组与0组之间对比,P<0.10,提示两组治疗后日常活动评分有差异；F组与0组之间对比,P<0.10,提示两组治疗后日常活动评分有差异；M组、F组明显优于0组。M组、F组、0组治疗前骨髓水肿评分,通过卡方检验,提示之间的差别不具有统计学意义(p=0.860)；治疗后三组之间的骨髓水肿分布情况通过卡方检验提示,三组之间差别具有统计学意义；并提示F组的0级水肿的发生率高于其他组别,而0组的0级水肿的发生率低于其他组别。M组、F组在骨髓水肿程度上,治疗后优于0组。
结论：
1、本研究显示在膝骨关节炎患者疼痛程度与骨髓水肿存在相关性。通过本课题研究,三个疼痛组(轻、中、重程度)的骨髓水肿发生率存在的差异有统计学意义,即随膝骨关节炎患者疼痛程度的加重骨髓水肿程度也有加重的趋势。
2、骨髓水肿已作为膝骨关节炎一个客观的量化指标用于临床上。由于膝关节应力的集中,导致膝关节力学平衡改变,并且筋膜和肌肉经反复的劳损,出现代偿性、增生性肥厚,加重膝软骨损伤。经筋组织为适应病变后的高应力,产生相应的变化。这些经筋病变加重膝骨关节炎病变程度,形成及加重骨髓水肿。基于此理论基础,本课题开展了关于经筋病症分型及骨髓水肿的相关性研究,并得到了随着膝骨关节炎经筋病变程度加重,骨髓水肿程度加重的研究结果。
3、经筋疗法治疗通过使用经筋手法及火针疗法治疗膝骨关节炎,分别对照治疗前及治疗后疼痛、僵硬程度、活动程度、骨髓水肿程度等。结果表明,两种经筋疗法对经筋分型膝骨关节炎治疗有明显疗效,并经筋疗法治疗组效果优于口服塞来昔布组。
4、经筋疗法,即通过手法“梳理”经筋走向、“松解”筋结点等肌肉、筋膜挛缩反应点,以及针对筋结点、筋聚点进行火针散刺。治疗经筋辨证分型膝骨关节炎,具有操作方法简单、效果明显并且安全性高等优点。通过经筋疗法针对“筋结点”的治疗,不但使经筋病的“筋痹”达到治疗效果,而且能改善膝部力学平衡状态及膝骨关节炎骨髓水肿(即“骨痹”状态)情况。通过经筋疗法治疗膝骨关节炎,可以达到“筋痹”及“骨痹”同治的效果!经筋疗法,为治疗膝骨关节炎提供一个安全有效的治疗方法,具有临床推广的意义。
5、经筋病变是膝骨关节炎“筋痹”,骨髓水肿是膝骨关节炎“骨痹”。本课题从临床试验,客观验证“筋痹”及“骨痹”阶段是同时存在的,即使在经筋病变的早期阶段,而到了膝骨关节炎的“骨痹”中后期阶段,经筋仍然起着重要作用。
Objective:
The knee is one of the most common sites of osteoarthritis, as a common disease, increasing attention has been paid on. Chinese medicine and modern medicine in the prevention of knee osteoarthritis have their growing understanding of profound. For knee osteoarthritis by Meridian-Muscle Syndrome Differentiation, our group has been committed to the direction of the research. Our studies had shown that from process of Meridian-Muscle theumatism development to Bone theumatism, Meridian-Muscle plays an important role, we believe that Meridian-Muscle theumatism is a necessary stage in the development of knee osteoarthritis, Bone theumatism is the extension of the development process of the Meridian-Muscle theumatism. In recent years, epidemiological studies of the knee have shown that bone marrow edema (BME) is a risk factor for osteoarthritis exacerbations. Bone marrow edema is very common in osteoarthritis. Through clinical trials, we had tried to explore knee osteoarthritis by Meridian-Muscle Syndrome Differentiations and Bone marrow edema. Bone marrow edema and knee osteoarthritis of through Meridian-Muscle Syndrome Differentiations can be an effective and objective evidence to provide the basis of clinical. Proved once again that knee osteoarthritis Meridian-Muscle theumatism is Bone theumatism s basic, Bone theumatism is an extension of Meridian-Muscle theumatism, Meridian-Muscle and Bone are also importance!
Method:
To explore the relationship between them, in the second part of the paper, we selected108patients with knee osteoarthritis, Knee rheumatism disease (knee osteoarthritis) in accordance with the State Pharmaceutical Management Department of Medical Administration22professional95disease TCM in treatment programs, According to the Chinese Academy of Sciences issued by the Meridian-Muscle Diagnostic criteria cases dialectical type, type the knee osteoarthritis, to analyze the distribution pattern and relationship with knee osteoarthritis and Bone marrow edema lesions. At the same time, analysis knee osteoarthritis X-ray stage with Bone marrow edema in clinical pain symptoms, thus re-examine the role of Bone marrow edema lesions in the knee osteoarthritis by Meridian-Muscle Diagnostic that has been ignored. In the third part of the paper,105patients with knee osteoarthritis patients, type by the Meridian-Muscle Diagnostic, treat with Meridian-Muscle Treatment, and with WOMAC score, Bone marrow edema score before and after comparison, to explore through the bars therapy treatment effectiveness. The results analysis statistically with SPSS13.0package, P<0.05considered to be statistically significant.
Result:
In the second part,108patients with knee osteoarthritis X-ray, through Bone marrow edema and Meridian-Muscle typing analysis their correlation. Severe X-ray findings accounted for90%of the patients with pain, show that patients with moderate to severe X-ray more pain than patients with mild X-ray, but pain ratings and X-ray classification contingency table x2test show that, Knee pain grading unrelated with X-ray grade (x2=3.791, P=0.435). Rank Sum Test results of numbers of independent samples show that X-ray classification of the three pain groups was not statistically significant (P=0.341). Severe Bone marrow edema in severe pain accounted for93.24%, patients with mild pain, only29.4%of patients with bone marrow edema. In patients with moderate to severe pain,75.8%of patients in the presence of one or more degree bone marrow edema, pain and bone marrow edema chi-square test tips show that the degree of pain relate with bone marrow edema grade (x2=20.254, P<0.01). Several independent samples comparison rank sum test results show that the three groups of patients with bone marrow edema grading have difference statistically significant (P<0.05), and research results show that:with the degree of pain has been increasing, the average rank of the bone marrow edema grading gradually increase (0degree41.01,1degree52.85,2degree66.21). It also shows that bone marrow edema relate with pain. Research results suggest that Bone marrow edema relate with pain, and with the aggravation of pain, bone marrow edema worsening trend.
The Meridian-Muscle lesions in severe bone marrow edema accounted for89.13%, Meridian-Muscle typing and bone marrow edema chi-square test, prompted that Meridian-Muscle typing relate with bone marrow edema grade (x2=14.959, P<0.01), tip that bone marrow edema type by Meridian-Muscle disease. Single Meridian-Muscle disease, two Meridian-Muscle disease and triple Meridian-Muscle disease group contrast visible, the single Meridian-Muscle disease compare with the Meridian-Muscle disease have a significant difference (P<0.05). Two Meridian-Muscle disease and three Meridian-Muscle disease has no significant difference (P>0.05). Several independent samples comparison rank sum test results show that the three groups of patients bone marrow edema grading difference statistically significant (P<0.05). And research results show that:with the degree of disease has been increasing through the Meridian-Muscle's number increased, the mean rank of the bone marrow edema grading gradually increased (0degree48.42,1degree59.74,2degree82.42), which also shows the bone marrow edema relate with Meridian-Muscle typing.
Through the Meridian-Muscle therapy, including the Meridian-Muscle massage (M group) and fire needle (F group) for the treatment on patients with knee osteoarthritis through the Meridian-Muscle Syndrome Differentiations and compare with oral celecoxib group (0group), the effectiveness of the WOMAC scores (pain, joint stiffness, activity level) and bone marrow edema rating grades inspection the Meridian-Muscle therapy. M group pre-treatment pain score was10.89±3.636, F group pre-treatment pain score was9.57±4.313,O group pre-treatment pain score was10.60±3.950, three sets of pre-treatment pain score two control, P>0.10, three groups before treatment have no difference in pain scores. M group after treatment pain score was5.74±3.257, the F treatment pain score was6.11±3.546, and the0group therapy pain score was8.11±3.948, difference between the three groups after treatment, pain score in two group, M group, F group comparison P>0.10, two groups after treatment have no different. Comparison between group M and group0, P<0.10, prompt treatment, pain score difference; Comparison between Group F and Group0, P<0.10, prompted the two groups after treatment pain score difference; M group, F group was significantly better than the0group. The M group before treatment stiff scores of4.17+2.007, the F group pre-treatment pain score was3.97±2.121,0group before treatment pain score was3.71±2.122, three groups before treatment stiffness scores two control, P>0.10, threebefore treatment, stiff rated no difference; M group treatment of stiffness after scores of3.11±1.762, F group pre-treatment pain score was3.17±1.9020group pre-treatment pain score was3.29±1.903, the stiff no difference in the ratings of the three groups after treatment. The M group before treatment activities ratings36.00±14.801, F treatment before the activity score36.69±15.231.0group before treatment activities ratings33.00±15.282; M group after treatment, the degree of activities rated21.57±10.869, F group therapy activities score was21.89±11.303,0group therapy activities score was27.89±14.481, three groups before treatment have no different P>0.05, in the ratings of three groups before treatment, activities have no difference. Activities score after treatment, M group scores21.57±10.869, F group score21.89±11.303,0group score was27.89±14.481, between the three groups score after treatment, the activities score of M group and F group comparison P>0.10, have no difference. Comparison between group M and group0, P<0.10, before treatment, activities score difference; contrast between the F group and the group0, P<0.10, prompt treatment, activities score difference; M group and F group was significantly better than the0group. The M group before therapy bone marrow edema score was2.00±0.840, F group before treatment bone marrow edema score was2.06±0.838,0group before therapy bone marrow edema score was2.17±0.822, three groups before treatment, bone marrow edema score, P>0.10, no difference in the three groups before treatment activities score. M group after treatment, bone marrow edema score of1.23±0.490, F group after treatment, bone marrow edema score was1.20±0.473,0group after treatment, bone marrow edema score was1.51±0.702; Group after treatment, bone marrow edema score between the groups, M group, F group comparison P>0.10, two groups after treatment, bone marrow edema score have no difference; comparison between group M and group0, P<0.10, prompt treatment, bone marrow edema score difference; contrast between the F group and the group0, P<0.10, prompt treatment, bone marrow edema score difference; M group, F group was significantly better than the0group.
Conclusion:
1. This study shows that patients with knee osteoarthritis, bone marrow edema (BME) correlated with knee pain. There was significant difference between the groups with pain of bone marrow edema incidence, with knee painincreased, bone marrow edema worsening trend. Typing knee osteoarthritis by Meridian-Muscle Syndrome Differentiations and bone marrow edema have correlation, the difference between the three through Meridian-Muscle groups and bone marrow edema have statistically significance, with increased knee pain, bone marrow edema worsening trend.
2. Bone marrow edema (BME) can be used as dialectically an objective quantitative indicators for clinical knee osteoarthritis of Meridian-Muscle Syndrome Differentiations. Mechanical equilibrium of the knee tendons lesions cause damage, stress concentration knee cartilage injuries were aggravated by the tendons of the human body to adapt to the presence of high stress in the lesion, the organization will produce a corresponding change. Stress concentration so that the muscle ligaments to spasm, fascia contracture, and the fascia and muscle will produce compensatory hypertrophy. In these tendon lesions lead to the knee mechanical equilibrium the limb alignment change, resulting in knee cartilage injury, adding to the severity of knee osteoarthritis, formed and increase bone marrow edema.
3. Meridian-Muscle therapy through the use of the Meridian-Muscle massage and fire needle therapy treatment of knee osteoarthritis, before and after treatment score comparison, results show that both methods by Meridian-Muscle therapy to knee osteoarthritis, the effect of the Meridian-Muscle therapy group was significantly superior to oral celecoxib group.
4. By Combing the Meridian-Muscle, Release Meridian-Muscle junction points and use fire needle treat Meridian-Muscle point of the scattered thorn treatment by gluten knee osteoarthritis, are safe operation and simple method, etc. Had provide a safe and effective treatment for patients with knee osteoarthritis, has a certain clinical significance.
5. Proved once again that knee osteoarthritis Meridian-Muscle theumatism is Bone theumatism basic, Bone theumatism is an extension of Meridian-Muscle theumatism, Meridian-Muscle and bone are also importance!
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