A Preliminary Exploration Of The Curative Effect Of Massage And Topical Voltaren Latex In The Treatment Of Bone Marrow Edema Of Knee Osteoarthritis

Objective:Clinically,it is found that patients with knee osteoarthritis have signs of bone marrow edema during MRI examination.Currently,the etiology and pathological mechanism of bone marrow edema are not clear.At present,it is believed that bone marrow edema will improve by itself after 6 to 8 months of protective loading.However,the long-term discomfort will bring physical and mental burden to the patient,so it is necessary to use therapeutic methods to relieve bone marrow edema.The purpose of this article is to explore the therapeutic effects of massage manipulation and external application of fortalin emulsion on bone marrow edema and clinical symptoms of knee joint.Methods:This study relies on the Beijing Municipal Science and Technology Commission project"Evidence-based Treatment Scheme of Traditional Chinese Medicine Massage and External Application of Diclofenac Diethylamine Emulsion in the Treatment of Knee Osteoarthritis:Randomized,Parallel Controlled,Multicenter Clinical Trials".The total number of major cases is 300,including 200 cases in the treatment group and 100 cases in the control group From July 2018 to November 2019,150 patients with mild to moderate KOA were collected from 4 sub-centers including Guang ’anmen Hospital of the Chinese Academy of Traditional Chinese Medicine,Oriental Hospital of Beijing University of Traditional Chinese Medicine,Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University and Beijing Xuanwu Hospital of Traditional Chinese Medicine.Among them,50 patients with BME signs on MRI were selected,33 of whom were treated with massage and 17 were treated with diclofenac diethylamine emulsion and set as control group.The index changes at the time of admission and after 10 weeks of treatment were observed.Main outcome measures:The BME of the largest subchondral layer was selected,and the area of BME of the same layer,the diameter of the maximum damage depth perpendicular to the articular surface and the diameter parallel to the articular surface were measured before and after treatment.Secondary indicators:WOMAC osteoarthritis index and CSKO score.Results:1.Through paired sample t test,the changes of BME area and maximum damage depth diameter perpendicular to articular surface in the treatment group before and after treatment have statistical significance(p<0.05),but the changes of maximum diameter parallel to articular surface have no statistical significance(p>0.05);The changes of BME area at the same level,the diameter of the maximum lesion depth perpendicular to the articular surface and the maximum diameter parallel to the articular surface in the control group before and after treatment were not statistically significant(p>0.05).WOMAC score and CSKO score before and after treatment in the treatment group and the control group have statistical significance(P<0.05);2.Through independent sample t test,there is no difference in BME area on the same plane,diameter of maximum damage depth perpendicular to articular surface and diameter parallel to articular surface,WOMAC score and CSKO score(p>0.05)between treatment group and control group before treatment,which is comparable.After treatment,the changes of BME area at the same level and the diameter of the maximum lesion depth perpendicular to the articular surface in the two groups were statistically significant(p<0.05).After treatment,there was no significant difference in the maximum diameter,WOMAC score and CSKO score parallel to the articular surface between the two groups(p>0.05).Conclusion:1.After treatment,the area of BME at the maximum level and the diameter of the maximum damage depth perpendicular to the articular surface in the treatment group are improved compared with those before treatment,and the treatment group is superior to the control group,so massage technique can improve BME;However,the control group could not effectively reduce BME;2.Both treatment group and control group can effectively improve KOA clinical symptoms;3.The clinical symptoms of the treatment group also improved with the improvement of bone marrow edema.However,the clinical symptoms of the control group were significantly improved without effective relief of bone marrow edema.