| ObjectiveTo observe characteristics of subchondral micro-perfusion in different stages of knee joint degeneration, dynamic contrast-enhanced MRI technology(DCE-MRI) were applied in patients undergoing total knee arthroplasty(TKA), patients with conservative treatment, and healthy people. The comparison and correlation were analyzed among medial and lateral compartment of distal femur and tibia plateau including subchondral micro-perfusion, subchondral vascular pathology, Mankin score, KSS score, aiming to figure out the potential relationship among those compartments’subchondral micro-perfusion in knee joint, as well as the pathologic change and knee joint degeneration. A randomize, single blind, simulation prescription parallel control trial was applied to evaluate the effect of Jingui external lotion in the treating knee osteoarthritis. Aiming to investigate the clinical effect on Tongluo Qubi therapy which Jingui external lotion function as, subchondral micro-perfusion was measured via DCE-MRI, as well as KSS score, VAS on tender point of the knee.MethodBasic research part:Knee osteoarthritis patients were enrolled and randomly divided into two groups-20patients in operation group and15patients in conservative treatment group, as well as15volunteers as healthy group. MRI examination (3.0T Magnetom Trio Tim SIEMENS) were applied in all. subjects, to acquire multiple sequence images and sagittal dynamic contrast-enhanced images.3D images of the knee joint were rebuild by Leonado workstation. The sagittal dynamic contrast enhanced sequence images and the intensity-time curve were attained with Mean Curve function.4similar subchondral rectangle interesting regions(area:pixel:30) were selected in medial and lateral compartment of distal femur and tibia plateau, then measure the enhanced rate and maximum upslope of these regions.In operation group, KSS score and VAS score in4regions (medial, lateral, anterior, posterior)of the knee were attained before surgery.20tibial plateaus and distal femur specimens were taken form patients afterTKA. Then, refers to the interesting regions in knee DCE-MRI, we sawed off the pieces(2*2cm) from medial tibia plateau and distal femur, and lateral tibia plateau and distal femur. To use the hematoxylin-eosin staining for these pieces after they had been decalcified, and observed the damage to the knee cartilage through Mankin score. We count the average number of blood vessel in10random views at200x as the number of invading blood vessel in cartilage.Clinical research part:Knee osteoarthritis patients scheduled for conservative treatment were enrolled and randomly divided into two groups18patients in Jingui external lotion group and18patients in Simulative external lotion group. All patients should washout or hydropathic compress their knee pain spot with washcloth20-30minutes(once or twice a day, no less than11times a week). To investigate the KSS score, range of motion (ROM), tender point VAS on medial, lateral, anterior, posterior side of all patients before and1week after the treatment. DCE-MRI was applied in both two groups before and1week after the treatment, and4subchondral rectangle interesting regions (area:pixel:30) were selected with similar specification in medial and lateral compartment of distal femur and tibia plateau, then measure the enhanced rate and maximum upslope of these regions.ResultBasic research part:The maximum upslope of medial distal femur and lateral tibia plateau, the maximum upslope and enhanced rate of the medial tibia plateau have shown significant difference between operation group and conservative treatment group. The maximum upslope and enhanced rate of medial distal femur and tibia plateau, the maximum upslope of lateral tibia plateau have shown significant difference between operation group and healthy group.There are no significant statistical difference in enhanced rate, maximum upslope and subchondral blood vessel invading between the interesting regions of medial distal femur and tibia plateau, except Mankin score. The same as interesting regions of lateral distal femur and tibia plateau was found. There are significant statistical difference in enhanced rate, maximum upslope and subchondral blood vessel invading between the interesting regions of medial and lateral distal femur, except Mankin score. The same as interesting regions of medial and lateral tibia plateau was found.Our research had shown positive correlation between medial distal femur’s enhanced rate and number of invading blood vessel(HE,200x), medial distal femur’s maximum slope and number of invading blood vessel (HE,200x), medial distal femur’s Mankins score number of invading blood vessel (HE,200x), medial tibia plateau’s enhanced rate number of invading blood vessel(HE,200x). Clinical part:There are significant statistical difference in KSS clinical and functioin score, ROM, anterior VAS, posterior VAS between before and1week after the treatment in Jingui external lotion group. The data shown in Simulative external lotion group is the same as Jingui external lotion group except posterior VAS. There are significant statistical difference in enhanced rate on medial distal femur and tibia plateau. Medial distal femur and tibia plateau maximum slope, lateral enhanced rate and maximum slope of femur and tibia plateau showed no significant difference.Our research had shown significant statistical difference in KSS clinical and functioin score, enhanced rate of medial distal femur and tibia plateau between Jingui external lotion group and Simulative external lotion group after the treatment. In another word, the Jingui external lotion group had better clinical on treating knee OA than than Simulative external lotion group, partially reduce micro-perfusion on femur and tibia plateau.ConclusionBy the mean of DCE-MRI with comparison among healthy group, conservative treatment group and operation group, we found the higher state of subchdndral micro-perfusion had been shown with aggravating osteoarthritis, it had been shown up as the significant increasing of enhanced rate and maximum slope. All of the operation group’s data shows that the medial compartment’s enhanced rate and maximum upslope is larger than lateral compartment’s. It accords with the osteoarthritis has worse damage in medial compartment, and shows the high state of subchondral micro-perfusion in medial compartment. Meanwhile, we found a correlation between the high state of subchondral micro-perfusion and the number of invading blood vessel by using correlation comparison algorithm. Therefore, we believe that DCE-MRI, a noninvasive assessment technique of lesion perfusion status, can be used for quantitative research of pathology changes with subchondral angiogenesis. Through the method of random, single blind, parallel and control study of simulation prescription, results that the Jingui external lotion, with Tongluo Qubi function, has effective in relieving pain, meliorating joint function and partially reducing medial femur and tibia plateau micro-perfusion compare with Simulative external lotion. We find that with the therapy of Jingui external lotion, subchondral micro-perfusion was partially improved, combined with pain relief and functional improvement, consistent with Traditional Chinese Medicine theory that pain will relief when the Jinluo is more fluent and there is no qi-stagnancy and blood stasis. |
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