Clinical Study On The Efficacy Of Knee Joint Cleaning Combined With Traditional Therapy In The Treatment Of Knee Osteoarthriti

Objective: With the advent of an aging society,the treatment of knee osteoarthritis has attracted more and more attention.In this study,a meta-analysis of relevant literature was conducted to clarify the therapeutic effect of arthroscopic debridement for knee osteoarthritis.By reviewing the clinical data and follow-up data of patients who received arthroscopic debridement in our hospital,the effect of arthroscopic debridement in the treatment of knee osteoarthritis and its influencing factors were observed.In addition,a statistical analysis was carried out on the literature related to the treatment of osteoarthritis by traditional Chinese medicine,so as to understand the current application and research status of traditional Chinese medicine in the treatment of osteoarthritis.Finally,through the clinical trial to observe the curative effect of acupuncture combined with arthroscopic debridement in patients with knee osteoarthritis.Material and Methods: this study is divided into four partsPart one: Meta-analysis of arthroscopic debridement in the treatment of knee osteoarthritis.Pubmed,Cochrane,Web of Science,CNKI,Wanfang database were searched.Literatures were included according to the inclusion and exclusion criteria,and meta-analysis was performed.Part two: A study of factors related to the efficacy of arthroscopic cleansing in the treatment of knee osteoarthritis.The clinical data and follow-up data of patients who received arthroscopic debridement were retrospectively analyzed.According to the DICOM data obtained from non-weight-bearing magnetic resonance examinations,MIMICS17.0 software was used to measure the value of the narrowest joint space,and the patients were divided into three groups.Group,joint space less than 3mm is group A,joint space is 3mm-4mm is group B,and joint space is more than 4mm is group C,and the knee joint space,age,weight are evaluated by postoperative follow-up evaluation(WOMAC score,TUG,GROC score).The influence of factors such as index on the effect of arthroscopic debridement.Part three: Literature analysis of traditional Chinese medicine for the treatment of osteoarthritis in English.The SCI-EXPANDED database in the Web of Science Core Collection(WOSCC)was used as the data source for retrieval.The search strategy included: search formula #1,search subject:(Chinese Traditional Medicine)OR subject:(Kampo Medicine)OR subject:(Korean Traditional Medicine)OR subject:(Tibetan Traditional Medicine)OR subject:(East Asia Medicine)OR subject :(Chinese Herbal Drugs)OR Subject:(Acupuncture);Search #2 Subject:(Osteoarthritis);Search #3 #1 AND #2.Time span: 1995 to present(last update date: 2020-12-31).Index: SCI-EXPANDED.The Cite Space software was used to analyze and visualize the annual publications,subject distribution,country/institution distribution,journal distribution,author distribution and keywords,and to infer the application of TCM treatment in patients with osteoarthritis through keywords.condition.Part four: A randomized controlled study on the clinical efficacy of arthroscopic debridement combined with acupuncture and moxibustion on knee osteoarthritis.Patients with osteoarthritis of the knee who were included in the hospitalization were randomly divided into arthroscopic group,arthroscopic + physiotherapy group and arthroscopic + acupuncture group according to the random number table,and the arthroscopic group was given conventional arthroscopic cleansing,the physiotherapy group was given conventional arthroscopic cleansing treatment combined with physical therapy for 1 month,and the acupuncture group was added to the acupuncture treatment for 1 month on the basis of conventional arthroscopic cleansing treatment.All patients were followed up for 1 year,with WOMAC scores,GROC scores,and TUG tests assessed at the end of 3 months,6 months,and 1 year of follow-up,respectively.Results:1.77 articles were included in the meta-analysis,including a total of 4409 patients.Eleven studies included 700 patients and compared the difference between the early postoperative Lysholm score and preoperative score after arthroscopic debridement.The results of meta-analysis showed that the early postoperative Lysholm score was 21.08 higher than the preoperative average.A total of 30 studies involving 1625 patients compared the Lysholm score at 1-month postoperative follow-up with the preoperative Lysholm score.The results of the meta-analysis showed that compared with the preoperative Lysholm score,the mean Lysholm score at 1-month postoperative follow-up increased by 21.51.A total of 25 studies included 1319 patients and compared the Lysholm score at the 3-month follow-up after arthroscopic debridement with the preoperative Lysholm score.The mean Lysholm score increased by 28.69.A total of 35 studies included 1810 patients and compared the Lysholm score at 6-month follow-up after arthroscopic debridement with the preoperative Lysholm score.The results of meta-analysis showed that the average Lysholm score at 6-month follow-up was higher than the preoperative average.Lysholm score increased by 25.50.A total of 25 studies included 1175 patients and compared the difference between the long-term Lysholm score after arthroscopic debridement and the preoperative Lysholm score.The results of meta-analysis showed that the average Lysholm score at 6-month follow-up was higher than the preoperative average Lysholm score.Increase 28.13.2.A total of 245 patients with knee osteoarthritis who underwent arthroscopic debridement were included,22 were lost to follow-up after surgery,and 223 were effective cases.There was no difference in basic data such as WOMAC score and TUG index.The postoperative effect of group B and group C was better than that of group A at different time points of 3 months,6 months and 1 year after operation.worse or even worse.Through Logistic regression analysis,joint space and BMI index can affect the effect of arthroscopic surgery,while age has no obvious correlation with the effect of arthroscopic surgery.Using ROC to analyze the joint space measured by MRI,it is found that a joint space of 2.7 mm is the boundary of prognosis In addition,using ROC to analyze body mass index(BMI),it was found that a BMI greater than 28.1 was the cut-off point for prognosis.,that is,a BMI greater than 28.1 indicates a less significant improvement after arthroscopic debridement(ie,a GROC of less than 3).3.A total of 914 relevant research papers were published,including 657(71.9%)papers,159(17.4%)review papers,43(4.7%)editing materials,31(3.4%)letters,and 21(3.4%)conference abstracts.2.3%),13(1.4%)conference papers,5(0.5%)priority publications,2(0.2)collections,1(0.1%)note;the total number of citations is 24,713 times,h The-index count is 68,and the average number of citations per item is 27.04;the number of papers published and the number of citations are increasing year by year.With the help of Cite Space V software,the national visualization map(Figure 3): N=21,E=61(N represents the number of network nodes,E represents the number of connections);the organization visualization map(Figure 4): N=133,E=373,the top 5 countries with the most published papers: China,the United States,Germany,South Korea,and Australia;the top 5 countries with the centrality ranking are China,the United States,Australia,South Korea,and Germany;the institutions with the most published papers are: Univ Maryland,Beijing Univ Chinese Med,Fujian Univ Tradit Chinese Med,etc.,and institutions with higher centrality include: Univ Maryland,Kyung Hee Univ,China Acad Chinese Med Sci,etc.Domestic scholars published a large number of papers and carried out more cooperation,but the citation analysis showed that the top five were all foreign scholars.The distribution of journals shows that journals such as Osteoarthritis And Cartilage,Acupuncture In Medicine,Arthritis Rheum-Us have a large number of published papers and a high centrality.Keyword analysis showed that the hotspot of related research is the research related to acupuncture treatment of osteoarthritis.4.After arthroscopic cleansing and postoperative treatment for one month and follow-up for 1 year,most of the patients had significant improvement in symptoms.The main performance is that the overall WOMAC score is significantly lower than the baseline level,and the score of each sub-item is also significantly reduced.At the 3 months postoperative period,there was no difference in the overall WOMAC score,pain score and limb stiffness score,and only in the limb function score,the physiotherapy group and acupuncture group were better than the arthroscopic group.At 6 months after surgery,there were significant differences in the total WOMAC score of each group,the acupuncture group was better than the physiotherapy group than the arthroscopic group,the limb function score was better than the arthroscopic group,the pain score of each group was no difference,and the acupuncture group was better than the other two groups.At one year after surgery,each group had significant differences in the total WOMAC score,with the acupuncture group being better than the physiotherapy group being better than the arthroscopic group;the limb function score being superior to the arthroscopic group;the acupuncture group being better than the other two groups in terms of pain score;and the limb stiffness score being better than the other two groups.The GROC score showed that the postoperative group achieved good clinical results,and the acupuncture group and physiotherapy group were better than the arthroscopic group at each postoperative follow-up time point,but there was no significant difference between the acupuncture group and the physiotherapy group.At the same time,the TUG test showed that the time required for the physiotherapy group and the acupuncture group was significantly reduced compared with the baseline,while there was no statistical difference at each time point compared with the two groups,and both were better than the arthroscopic cleansing group alone.Conclusion:1.Arthroscopic cleansing for knee osteoarthritis has a rapid onset of action,stable efficacy,and good medium-and long-term effects.2.Joint space width and BMI are two independent factors that affect the efficacy of knee arthroscopic cleansing.For patients with KOA with joint space width(MRI measurement)<2.7 mm and/or body mass index BMI >28.1,arthroscopic cleansing should be chosen with caution.3.The application of traditional Chinese medicine treatment in osteoarthritis is increasing year by year,and its main technical method is acupuncture.4.Physiotherapy combined with arthroscopic cleansing,acupuncture combined arthroscopic cleansing in the treatment of patients with knee osteoarthritis,the efficacy is better than arthroscopic cleansing alone,and there are significant differences.There was no significant difference between the efficacy of acupuncture combined arthroscopic cleansing in the treatment of knee osteoarthritis and physiotherapy combined with arthroscopic cleansing.