The Distribution And Evaluation Of TCM Syndrome Types During The Perioperative Period Of Knee Osteoarthritis Joint Replacement Based On Syndrome Differentiation

Background:With the development of modern surgery,more and more patients and doctors choose artificial joint replacement surgery for end-stage knee osteoarthritis.However,due to the continuous increase of human lifespan and the continuous improvement of patient expectations,this new treatment method will also bring new problems and challenges while treating patients with primary disease.How to reduce postoperative complications,accelerate rapid postoperative recovery,and prolong prosthesis life are the focus of research in this field.Traditional Chinese medicine plays an important role in perioperative period of knee replacement.However,how to establish scientific and standardized TCM syndromes based on the characteristics of TCM,and guide the application of TCM in the perioperative period of knee joint replacement as a whole,are still not solved in this area.The deficiencies and defects need further research and improvement.This research is conducted in three parts.Part 1.Analysis of TCM Syndrome Research Based on Bibliometrics and visualizatrion softwareObjective:To provide an objective research method for further research on the distribution of syndrome types in the perioperative population of knee osteoarthritis arthroplasty.Method:The first part is to make an objective and comprehensive analysis of current TCM syndrome research by using bibliometric methods and visualization software.Search CNKI,Wanfang,and CBM databases in strict search format.To import the search data that complies with the standards into Excel 2010 and Graphpad Prism 6 software and draw the trend chart.The inclusion and arrangement of the subject information is carried out using BICOMS software,and the term and co-occurrence matrix is finally generated.The visual analysis of other types of information uses Ucinet6.The Net-Draw function in the software is performed,and the social network analysis diagram is finally drawn.The clustering analysis of the text matrix is performed using the University of Minnesota’s graphic clustering toolkit Gcluto2.0,and a visual matrix and hill map are generated.Result:A total of 2817 documents were included in the analysis,involving a total of 3870 authors.Among them,Li Candong and Professor Zhu Wenfeng ranked the top two.The author’s network diagram indicates that Zhu Wenfeng has the most active cooperative relationship among all authors.The Hunan University of TCM has the largest number of papers and has published 179 papers.The journal with the largest number of articles was"Chinese Journal of TCM",with a total of 174 articles.The most frequent key word appeared was "Zhengsu",which appeared a total of 902 times.Cluster analysis of 29 keywords with frequencies greater than 50 suggests that the current research in the field of TCM syndromes in China is mainly divided into three major topics.Topic 1:Data Mining/Literature Research/Pathogenesis/Symptoms/Sickness/Sickness and TCM Research.Topic 2:Coronary Heart Disease/Symptoms and Treatments/TCM Syndrome Type/Factor Analysis/Cluster Analysis/Symptom Elements/Differential Classification.Topic 3:Type 2 Diabetes/Metabolic Syndrome/TCM Syndrome/Side Syndrome/Sick Syndrome/Clinical Research.Conclusion:Bibliometrics suggests that Professor Zhu Wenfeng has a huge influence in the field of TCM syndrome research,and his syndrome differentiation is the mainstream method of TCM syndrome research.Part 2.Study on the distribution of syndrome types in perioperative period of KOA arthroplasty based on syndrome differentiation and syndrome clusteringObjective:To establish the distribution characteristics of syndrome types of patients in perioperative period of KOA arthroplasty from the overall level,and integrate the overall syndrome differentiation scheme of TCM into the clinical treatment system of perioperative period of KOA arthroplasty.Method:The second part is also the core part of this study.It studies the distribution characteristics of TCM syndrome types during perioperative period of knee osteoarthritis joint replacement by using syndrome differentiation and symptom clustering.A cross-sectional questionnaire survey was used to collect and summarize the four TCM diagnosis information of each patient at different nodes on the day before surgery,the third day after surgery,the seventh day after surgery,and the fourteenth day after surgery;The distribution frequency of the diagnosis information,using SPSS22.0 software to perform R-type variables and dichotomous variables of TCM diagnosis information with a distribution frequency of 10%or more.At the same time,we calculated the characteristics of each patient’s syndromes according to the simplified method of the syndromes in Professor Zhu Wenfeng’s "TCM syndrome differentiation",compiled all the information of TCM syndromes obtained through calculation,and took the distribution frequency higher than 10%.The TCM syndrome information was clustered using SPSS22.0 software to form a TCM syndrome distribution group.The information of the syndrome and the information of the four TCM clinics were compared and analyzed,and the distribution of the syndrome types was finally obtained through an oral vote of the experts.Result:In the second part,a total of 165 cases with complete data were collected,including 42 males(25.4%)and 123 females(74.6%).The ratio of male to female was approximately 1:3.The youngest was 55 years old and the oldest was 84 years old,with an average age of 69.62 ± 5.85 years.There were 56 symptoms with a frequency greater than 10%on the day before surgery,which were divided into three groups after cluster analysis;15 items with a frequency greater than 10%on the day before surgery,were divided into three groups after cluster analysis;one day before surgery The distribution of syndrome types is:Syndrome type Ⅰ:blood stasis and obstruction;Syndrome type Ⅱ:liver and kidney deficiency;Syndrome type Ⅲ:cold and damp stagnation.Three days after the operation,there were 44 symptoms with frequency higher than 10%,and 14 symptoms with frequency greater than 10%.After cluster analysis,the symptoms and syndromes were divided into four groups.Syndrome type Ⅰ:Deficiency of Qi and Blood,Syndrome Type Ⅱ:Qi Stagnation and Blood Stasis;Syndrome type Ⅲ:Cold and damp stagnation;Syndrome type Ⅳ:Liver and kidney deficiency.Seven days after the operation,there are 37 symptoms,and the symptoms are more than 10%.The symptoms and syndromes are divided into three groups after cluster analysis.The syndrome distribution is as follows:Syndrome type Ⅰ:Qi and Blood deficiency and liver and kidney deficiency;Syndrome type Ⅱ:Qi stagnation and Blood stasis;Syndrome type Ⅲ:cold and damp stagnation.Fourteen days after the operation,there were 44 symptoms with a frequency greater than 10%,and 13 symptoms with a frequency greater than 10%.After cluster analysis,the symptoms were classified into three categories.Syndrome type Ⅰ:Qi deficiency and Blood deficiency;Syndrome type Ⅱ:Cold and damp stagnation;Syndrome type Ⅲ:Liver and kidney deficiency.Conclusion:Preoperative and postoperative perioperative period of knee osteoarthritis joint replacement There are differences in the distribution of TCM syndrome types,and there are two types of deficiency of Qi and Blood at different node types after surgery.Part 3.Verification of the distribution of TCM Syndrome Types in perioperative period of KOA arthroplasty based on clinical efficacy evaluationObjective:To verify the TCM syndrome differentiation of knee replacement in perioperative period based on the evaluation of clinical curative effect.Method:The third part is to evaluate the curative effect of different types of TCM syndromes after knee joint replacement using the methods of Systematic review and Network of meta-analysis.Retrieve random randomized controlled trials(RTCs)of TCM for prevention and treatment of perioperative complications of knee replacement.The methods of TCM were classified according to the Text books of traditional Chinese medicine.The quality of the literature was evaluated according to the Cochrane collaborative network system evaluation method.Stata 14.0 software was used for statistical analysis.CI evaluates the consistency of each closed loop,uses a funnel plot to analyze small sample effects and potential publication bias,and uses the area under the SUCRA to predict the efficacy ranking of each syndrome type.Result:59 articles that meet the criteria are included.Consistency check indicates that the inconsistency factor is between 0-3.076,and the consistency is good.The funnel plot indicates that the funnel plot is basically symmetrical and the regression line is at a basic level,suggesting that the study does not have small sample effects and publication bias.According to the prediction interval map and the network league map detection,the three measures of nourishing qi and blood+routine program,Qi Method+routine program,and Liver and Kidney+routine program are better than conventional methods in preventing and treating complications after knee replacement.The RR and 95%CI are[0.31(0.23,0.43),0.27(0.10,0.72),and 0.31(0.14,0.71)].The area under the SUCRA is cumulatively sorted,and nourishing Qi and Blood+conventional plan(84.3)>Qi Method+Conventional Program(81.5)>Liver and Kidney+Conventional Program(79.7)>Qi Supplement(34.1)>Liver and Kidney(33.6)>Supplement Qi and Blood(21.7)>Conventional Program(15.1).Conclusion:Systematic review and reticulated meta-analysis suggest that the effect of nourishing Qi and Blood combined with conventional therapy after knee replacement is better than other syndromes.