| ObjectiveKnee osteoarthritis (OA) was a common, chronic, and progressive disease in the eldly.In recent years, along with the world's aging population increases, the incidence rate showed an increasing trend, at present, there was lack of cure methord. Chinese medicine thought it was Bi syndrome of bone, blood stasis was the main pathogenesis and Huoxuetongluo was an important treatment of this disease. Western medicine thought pathogenesis of Knee OA had closely relation with the IL-1, particularly IL-1β. Studies showed that drugs which could inhibit or reduce the production of IL-1βcould alleviate the symptoms of knee OA and slow its progress.The features of Arthroscopic debridement were minimally invasive, quick recovery, simple, safe and effective. Therefore this study was to treat the disease with arthroscopic debridement combined Huoxuetongluo gel, to observe the clinical outcome and concentration change of IL in the serum and synovial fluid. Meanwhile, the reacher studied how the huoxuetongluo gel effect on free radica, IL-1βmRNA, immunohistochemistry, and many other effects of rabbit, to analize the possible mechanism of treatment of knee OA with Huoxuetongluo gel from the perspective of cytokines and provide new experimental data and ideas for treatment of knee OA.Methods1. Clinical Research96 cases were divided into two groups randomly:treatment group and control group. The treatment group were treated with arthroscopic debridement combined Huoxuetongluo gel which external apply the knees, each 1g to cover the whole jiont, qd,2 weeks as a treatment course, interval of 2 days, went to the next treatment course, the total course of treatment for 3 months;the control group were treated with arthroscopic debridement only. Knee OA scoring table was formulated for calculatig the clinical score according to Lequesne index of severity and activity assessment, the full score was 16 points, divided into the following five levels:16 to 13 points,12 points to 9 points 8 points to 5 points,4 points to 1 point,0. If the score went to 0, it wss clinical cure, advanced two levels was marked effect, advanced one level was effective, less than a grade was invalid; and in, blood and knee joint synovial fluid were extracted during surgery and 1 month after treatment, preservated at-20℃, which were detected at the same time to determine the IL-1 levels by using double-antibody sandwich ELISA method.2. Experimental study50 75-days-old Japanese white rabbits were randomly divided into blank group, model group treatment group,,30 in model group, and the remaining 10 in each group. In addition to the control group, the remaining 40 rabbits were modified by modeling Hulth method. Treatment began 1 week after the modeling, a rabbit was feed in one cage. Model group were conventional breeded; treatment group received topical gel Huoxuetongluo,0.1g each time to cover the whole knee for 4 weeks as a course of treatment, a total of 3 courses.After the treatment, firstly all the rabbit were phlebotomized 3ml blood from ear vein, secondly were killed by air embolism. A sharp blade was used to cut off some cartilage at the middle part of the knee joint, serum was separated for SOD and LPO detection, cartilage was used to detecte water content, content of hexuronic acid and hydroxyproline, quantity of expression of IL-1βmRNA and content of IL-1β.Results1.Clinical studyAfter treatment, total effective rate of treatment group was 93.6%, that of control group was 83.7%, effective rate of treatment group was better than control group with significant difference (P<0.05), Contents of IL-1 in serum and synovial fluid were significantly lower in the two groups, the treatment group lower than the control group with significant difference(P<0.05). 2. Experimental studyThis study succeeded to establish a rabbit model of knee OA by Hulth method at 8th week IL-1βexpression au the 8th week reached a peak, then gradually decreased, but IL-1βmRNA increased at earlier time, then gradually down regulated.After treatment, levels of serum SOD content increased compared with the model group with significant difference,P<0.05, levels of serum LPO were significantly decreased compared with the control group, P<0.01; Cartilage Water content of treatment group was lower than model group with, significant difference, P<0.05. Uronic acid content and hydroxyproline content of the treatment group was higher than the model group with significant difference, P<0.01. IL-1βmRNA expression of treatment group was lower than the model group with significant difference, P<0.05. IL-1βexpression by immunohistochemistry was significantly lower than the model group, P<0.01, the difference was statistically significant.ConclusionsThe research treated knee OA with arthroscopic debridement as the basis and Huoxuetongluo gel which could promote blood circulation to remove meridian obstruction, and gained good outcome, Huoxuetongluo gel played an obvious synergistic effect after operation. The his advantages of the therapy were less invasive, quick recovery, simple, safe, easy to adhere, etc. The treatment could effectively slow down the degradation of cartilage by reducing IL-1 levels, delay the time of artificial joint replacement; significantly alleviate the suffering of patients and the economy burden, improve their quality of life.The research established rabbit model of knee OA by Hulth, IL-1βexpression reached a peak at the 8th weeks, then gradually decreased, while IL-1βmRNA become downward trend gradually after the initial higher. May be it related to early traumatic reaction, with the wound healing the expression decreased gradually. However at the 12th weeks after modeling, X-ray showed advanced performance of osteoarthritis, it was not suitable for study on early-mid-phase of OA. Therefore, study on prevention and treatment for early-mid-phase of knee OA should choose experimental OA model at the 8th week.Huoxuetongluo gel prevented cartilage from further damage by reducing the expression of IL-IβmRNA of cartilage and reducing joint local and systemic IL-1 levels. It reduced damage of oxygen free radicals on articular cartilage and promoted repair of cartilage by improving metabolism of oxygen free radical and cartilage biochemical of knee OA model to enhance the role of antioxidant free radical.
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