Study On The Evaluation Of Relationship And Prognosis Of "Jin" And "Gu" In Knee Osteoarthritis Based On Imaging

ObjectiveMagnetic resonance imaging and X-ray imaging were used to observe the common image pathological changes of Knee Osteoarthritis(KOA)during the pathological process.The imaging morphological manifestations of KOA were summarized and classified,the evaluation model was established according to the thought of "emphasizing both "Jin" and"Gu" "in TCM theory,and the correlation between "Jin" and "Gu" related factors and the correlation between the treatment methods were analyzed,and the KOA treatment and prognosis regression related to "Jin" and "Gu" were established.Using the data evaluation results of modern imaging technology,study the pathogenesis and treatment principles of"Jin" and "Gu" about knee osteoarthritis in traditional Chinese medicine,which is "treat from the "Jin",pay equal attention to the "Jin" and "Gu",and put the "Jin" first.MethodsThis clinical study is a cross-sectional retrospective case analysis study.According to the inclusion and exclusion criteria,a total of 122 patients with osteoarthritis were collected as the research objects,who met the criteria from March 2019 to June 2022 in the Department of Orthopedics,Wuwei Tumour Hospital,Gansu Province.All patients underwent sagittal SAG-PD-FS proton fat suppression sequence,sagittal T1-TSE sequence,coronal COR-PD-FS proton fat suppression sequence,transverse Axial TRA-PD-FS proton fat suppression sequence scan at the same Siemens 3.0T superconducting magnetic resonance instrument,the diseased joints of KOA were examined.Hire 3 senior doctors with more than 5 years of musculoskeletal tissue nuclear magnetic imaging diagnosis technology,in a semi-quantitative evaluation mode,refer to ACLOAS method,WORM method,Guermazi method,MOAKS method,etc,using the hospital PACS system,on the conventional MRI image pictures to carry out the femur,tibia,patella region of interest Classification,assessment of imaging manifestations such as articular cartilage surface defect,osteochondral surface injury,subchondral injury,periarticular osteophyte,abnormal joint structure and morphology,ligament degeneration injury,joint effusion and synovial inflammation,meniscus injury such as tear and extrusion,periarticular tendon attachment abnormal point signal,abnormal bursa signal,loss of joint stability,etc.The corresponding data is recorded completely and then formed into XLSX file for backup.According to the description of the concept of "Jin" and "Gu" in the theory of traditional Chinese medicine,the relevant assessment items are divided into the categories of "Jin" and "Gu";principal component analysis is used to calculate the weight of each factor in the comprehensive scoring model,based on the variance contribution rate of each factor,and an evaluation system for "Jin" and "Gu" is established.The principle of 1:1 finally forms a comprehensive score of "Knee Arthralgia",and the relevant data is applied to the data analysis process.In the process of correlation analysis of each factor,this data processing process is used to obtain the comprehensive score of the factor.On the basis of the original evaluation model,the correlation results between each factor in the model and the comprehensive score,the K-L grade and the treatment method were evaluated through data analysis,and the evaluation model was further simplified,and the prognosis model was finally established.In the process of data analysis,the Lasso-cox regression model was programmed in R language,and the rest of the data was processed by SPSS 20.0 software.The corresponding data included interval data,ordinal data,and fixed type data.Select specific data verification according to different data and test types.The test methods including Kendall’s tau_b test,Spearman’s rho test and Pearson correlation test.ResultsSection 1.Image morphologic study and semi-quantitative clinical evaluation of KOA1.General status statistics of the selected cases:There were 40 males and 82 females.The age of most cases was between 45 and 75 years old,the minimum age was 32 years old,the maximum age was 86 years old,the median age was 57 years old,and the average age was 57.95 years old.The body weight is distributed between 50kg and 90kg;The minimum weight was 48kg,the maximum weight was 88kg,the median weight was 64kg,and the mean weight was 65.802kg.Most of the BMI was between 20 and 30,the minimum BMI was 19.4,the maximum BMI was 43.8,the median BMI was 24.35,and the average BMI was 24.87.Femoral trochlear morphology was N67 cases,17 cases of type A,30 cases of type B,6 cases of type C,1 case of type D,and 1 case of deletion.The patella morphology was type Ⅰ in 58 cases,type Ⅱ in 58 cases,and type Ⅲ in 6 cases.The Caton index was low in 14 cases,normal in 102 cases and high in 6 cases.2.In the course of my research,the KOA is belong to "Knee Arthralgia"in traditional Chinese medicine,for patients with KOA lesions of different K-L grades,there are articular cartilage surface defects,osteochondral surface damage,subchondral damage,periarticular osteophytes,abnormal joint structure and morphology,ligament degeneration and damage,joint effusion and synovial inflammation,meniscus injury,tearing and extrusion,abnormal signal of tendon attachment points and bursa around the joint,loss of joint stability and other imaging manifestations,the above imaging morphological are common pathological features and manifestations in KOAMRI evaluation.Section 2.Preliminary establishment of a "Jin" and "Gu" related KOA imaging assessment model and the relation between general conditions and model.1.According to the "Jin" and "Gu" concept and the principle of "paying equal attention to the physique" to build "Jin","Gu" and Knee Arthralgia evaluation model,through the size of the main component analysis and variance contribution rate,select representative evaluation factors after analysis and calculation for composite score,Applied to data analysis.2.Changes in disease course,routine disease course,age and KOA imaging assessment scores were analyzed by multiple correlation analysis,showing a positive correlation;weight,BMI,gender and KOA imaging assessment scores were analyzed by multiple correlation analysis,and there was no positive correlation.Section 3.The relationship between KOA imaging assessment and "Jin" and "Gu".1.In the correlation analysis between the signal changes of "Gu" and KOA imaging evaluation scores,there is a significant positive correlation between cartilage surface defects,osteophytes,bone marrow lesions,cartilage surface fractures and KOA imaging evaluation scores;Some sub-regional indicators were analyzed separately,and no correlation existed.2.There was no significant correlation between patella morphology and KOA imaging score.There was a significant negative correlation between patella height and KOA imaging score.Femoral trochlear morphology was significantly positively correlated with KOA imaging assessment scores.3.The degree of meniscus compression,the type of meniscus injury,the degree of meniscus injury were significantly positively correlated with the results of KOA imaging evaluation.Except for the posterior horn of the lateral meniscus,including posterior horn of medial meniscus,body of medial meniscus,anterior horn of medial meniscus,anterior horn of lateral meniscus,body of lateral meniscus,there was a significant linear correlation between the damage degree of meniscus and the comprehensive score of "Gu".4.In the correlation analysis between joint stability and scores of "Jin" and "Gu",there is no significant linear correlation between the posterior cruciate ligament angle and the "Jin" and "Gu".There was a linear correlation between the anterior distance of the tibia and the score of "Jin" when the significance=0.05,but there was no significant linear correlation between the anterior distance of the tibia and the score of "Gu".There was no significant linear correlation between disease duration and stability.5.In the correlation analysis of joint effusion,synovial thickness and the scores of "Jin" and "Gu",there is a significant positive correlation between joint effusion and synovial thickness and "Jin" and "Gu";ADL showed significant linear relationship with joint effusion.There was a significant positive correlation between joint effusion and KOA imaging score,and the correlation was moderate.6.There is a significant positive correlation between periarticular features,ligaments around the joints and KOA imaging score;there is no significant correlation between periarticular features and ADL,resting pain and BMI;There was a correlation between periarticular ligaments and ADL,but no significant correlation between periarticular ligaments and resting pain or BMI.Section 4.Study on the correlation between K-L grade and "Jin" and "Gu".1.The changes of age,course of disease and course of disease were positively correlated with K-L grade;There was no positive correlation between weight,gender and K-L grade.2.In the correlation analysis results of the "Jin"and K-L grading,K-L grading has a significant positive correlation with the degree of meniscus extrusion,injury types,fluid accumulation,synovial thickness,and periarticular ligaments.There was no significant correlation between the degree of meniscus injury,periarticular sign and K-L grade.3.Correlation analysis results of "Gu" related factors and K-L grading showed that there was a linear positive correlation between articular cartilage defect,subchondral bone marrow injury,osteocytes,cartilage surface injury,femoral trochlear morphology and K-L grading,while there was no linear positive correlation between patella morphology,patella elevation index and K-L grading.Section 5 Correlation between evaluation of "Jin" and "Gu" of KOA and treatment modalities1.The course of disease was positively correlated with the treatment;There was no positive correlation between age,weight,sex and treatment.2.Among the influences of "Jin" lesions on the changes of KOA treatment,tendon attachment points,extraarticular ligaments and intraarticular ligaments were significantly correlated with the treatment methods;Effusion synovitis(synovitis)and periarticular bursa were weakly correlated with treatment.Meniscus injury degree,meniscus extrusion degree,meniscus injury type and treatment methods were not significantly correlated.3.Among the influences of "Gu" score on the change of KOA treatment style,articular cartilage defect was significantly correlated with the treatment style;Osteophytes were weakly correlated with treatment.There was no significant correlation between subchondral injury,articular cartilage surface injury and bone morphological score and treatment styleSection 6 Simplification of evaluation model of "Jin" and "Gu" and establishment of prognosis modell.There is a significant positive correlation trend between K-L grading and KOA imaging assessment score.K-L grading corresponding to KOA imaging assessment score.There was a positive correlation trend between treatment style and KOA imaging assessment score,but the trend was very weak,indicating that there was a certain relationship between the two,but the choice of treatment style was also influenced by other factors.In the imaging evaluation results of KOA cases with different K-L grades,the proportion of "tendons" gradually decreased,while the proportion of "bones" gradually increased.Kendall-W concordance coefficient test showed that K-L grade was consistent with treatment.2.Subchondral bone marrow injury,bone morphological measurement,meniscus extrusion degree,meniscus injury degree,meniscus injury type and other related assessment factors that are not related to treatment methods were excluded,and those with similar representative significance to articular cartilage defects were excluded.Finally,an evaluation model based on factors related to articular cartilage defect,osteopathy,effusion synovitis,periarticular features,and periarticular ligaments was developed.3.The regression model with "articular cartilage defect","osteophyte","effusion synovitis","periarticular features","ligament","subpatellar fat pad" and "disease course" as independent variables,and treatment choice or disease prognosis as dependent variables,has a good degree of fit and benign.Conclusion1.Imaging manifestations of KOA lesions with different K-L grades include articular cartilage surface defect,osteochondral surface injury,subchondral injury,periarticular osteopathy,abnormal joint structure and morphology,ligament degeneration injury,joint effusion synovial inflammation,meniscus injury,tear and extrusion,abnormal signal of periarticular tendon attachment and bursa,loss of joint stability,etc.2.Body weight,course of disease,gender and age had different influences on KOA image score,K-L grading and treatment choice;3.After eliminating related factors unrelated to treatment methods,the evaluation models of "Jin","Gu"and Knee Arthralgia established under the guidance of the theory of"Jin" and "Gu" of traditional Chinese medicine can meet the requirements of comprehensiveness of the evaluation and have excellent health.4.There is a correlation between the evaluation data of related factors,which reflects the pathogenesis changes of "Jin" and"Gu" in traditional Chinese medicine of KOA and the treatment principle of "attaching equal importance to "Jin" and "Gu"";5.The regression model established with treatment method selection and disease prognosis as dependent variables has a good degree of fit and good health.The correlation analysis between "Jin" and "Gu" and treatment methods reflects the TCM treatment principle of "put the "Jin" first";6.K-L grading,choice of treatment,changes in the proportion of "Jin" and "Gu" in the progression of KOA lesions and other related analyses showed consistency with disease changes,and there was consistency in data analysis.Finally,based on the imaging evaluation model of knee osteoarthritis established under the guidance of traditional Chinese medicine "Jin" and "Gu" theories,the correlation analysis between "Jin" and "Gu" evaluation system and factors can reflect the pathogenesis changes of "Jin" and "Gu" and guide the prognosis.